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Publication Detail
Health-Related Quality-of-Life of HIV-Positive People with HIV in the Era of Combination Antiretroviral Treatment: a Cross-Sectional Comparison with the General Population
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Miners A, Phillips AN, Kreif N, Rodger A, Speakman A, Fisher M, Anderson J, Collins S, Hart G, Sherr L, Lampe FC
  • Publisher:
    Elsevier
  • Publication date:
    08/09/2014
  • Journal:
    Lancet HIV
  • Status:
    Accepted
Abstract
Background: Little is known about health-related quality-of-life (HRQoL) among people living with HIV in the era of combination antiretroviral therapy in comparison to the general population. It is also unclear whether HRQoL decreases with older age to a greater extent in HIV-positive people. Methods: Two UK cross-sectional surveys were merged (2011-12). They comprised of an unselected sample of people diagnosed with HIV attending outpatient clinics (n=3,151) and the Health Survey for England (n=7,424); response rates were approximately 65%. HRQoL was assessed using the EQ5D-3L instrument which measures health on five domains, each with three levels. The responses are scored on a scale where values of 1 and 0 represent ‘perfect health’ and ‘death’ respectively, known as the ‘utility’ score. Multivariable models compared utility scores between the population samples, adjusting for a number of socio-demographic factors, such as smoking. Findings: The EQ5D-3L utility score was lower for those with HIV compared to the general population (overall difference: -0•11; 95% CI: -0•13, -0•10). HRQoL was lower for all EQ5D-3L domains, particularly for anxiety / depression. The difference in utility score remained significant after adjusting for socio-demographic variables and was apparent across all CD4 and antiretroviral therapy / viral load strata, but was greatest for those diagnosed in earlier calendar periods. There was no evidence (p-value for interaction >0•05) that the reduction in HRQoL with age was greater among those with HIV compared to the general population. Interpretation: People living with HIV have significantly reduced HRQoL compared to general population levels, despite the majority in this study being virologically and immunologically stable. While this may in part be due to other factors, this study provides additional evidence of the loss of health that can be avoided by preventing further HIV infections, which is important information for cost-effectiveness analyses.
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