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Health-related quality of life in HIV-infected patients in a private practice in Germany

Background

With improved treatment options, HIV infection has become a well treatable disease. Nevertheless, chronic disease and toxicities of long-term therapy may impair quality of life (QoL).

Methods

Cross-sectional study (n = 209) using a self-administered 28-item-questionnaire (six scales measuring quality of life, SEL) validated for HIV patients. For statistical analysis non-parametric tests were used. Antiretrovirals used (>10 patients) were: lamivudine/emtricitabine 152, tenofovir 121, abacavir 32, zidovudine 30; NNRTIs: efavirenz 50, nevirapine 28; PIs: lopinavir 31, atazanavir 17, saquinavir 12, darunavir 11.

Summary of results

Mean age 44 years; 89% male. CDC stage (1998) was A 44%, B 32% and C 24%. 80% received ART.

No difference in overall QoL between treated (3.62 ± 0.79) and untreated patients (3.66 ± 0.80) (p = 0.78) was observed. All patients rated their physical state better (QoL-P) (3.73 ± 0.85) than their cognitive-emotional (QoL-CE) (3.44 ± 0.86) (p < 0.001), regardless of being treated or not. There was no correlation between CD4+-cells and any QoL-domain. Patients in stage CDC A had a better QoL in all domains compared to patients with a history of symptomatic infection CDC B or CDC C (p < 0.05).

Patients on NNRTIs reported a better QoL than patients on PIs for QoL-P (3.91 ± 0.79 vs. 3.58 ± 0.87), QoL-CE (3.65 ± 0.83 vs. 3.31 ± 0.89) and overall QoL (3.80 ± 0.81 vs. 3.48 ± 0.84) (all p < 0.05). However, a higher proportion of patients with advanced HIV infection were treated with PIs compared to NNRTIs: CDC A 34%/61%, CDC B 59%/42%, and CDC C 56%/40% (p < 0.05).

Overall, QoL-score was lower in HIV+ patients (3.63 ± 0.79) than in the healthy reference sample (3.81 ± 0.53) but better than the historic HIV+ sample (3.51 ± 0.62) from mid-1990s. Improved QoL of HIV+ patients with and without current antiretroviral therapy compared to patients from mid-1990s was observed in all QoL domains.

Conclusion

HIV+ patients rate their QoL worse than healthy controls but better than HIV+ individuals from mid-1990s. Compared to HIV-negative individuals, QoL is impaired in the cognitive-emotional domain independent of health status. This suggests that being HIV-infected represents an emotional stress despite improved physical well-being. Effects of different drug classes should be interpreted carefully due to a potential selection bias.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mauss, S., Henke, J., Berger, F. et al. Health-related quality of life in HIV-infected patients in a private practice in Germany. JIAS 11, P160 (2008). https://doi.org/10.1186/1758-2652-11-S1-P160

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  • DOI: https://doi.org/10.1186/1758-2652-11-S1-P160

Keywords

  • Zidovudine
  • Tenofovir
  • Efavirenz
  • Nevirapine
  • Saquinavir