Health-related Quality of Life in Patients with Human Immunodeficiency Virus Infection in the United States

Results from the HIV Cost and Services Utilization Study

Published in: American Journal of Medicine, v. 108, no. 9, June 15, 2000, p. 714-722

Posted on RAND.org on January 01, 2000

by Ron D. Hays, William Cunningham, Cathy D. Sherbourne, Ira B. Wilson, Albert W. Wu, Paul Cleary, Daniel F. McCaffrey, John Fleishman, Stephen Crystal, Rebecca L. Collins, Ferd Eggan, Martin F. Shapiro, Samuel A. Bozzette

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PURPOSE: To measure health-related quality of life among adult patients with human immunodeficiency virus (HIV) disease; to compare the health-related quality of life of adults with HIV with that of the general population and with patients with other chronic conditions; and to determine the associations of demographic variables and disease severity with health-related quality of life. SUBJECTS AND METHODS: The authors studied 2,864 HIV-infected adults participating in the HIV Cost and Services Utilization Study, a probability sample of adults with HIV receiving health care in the contiguous United States (excluding military hospitals, prisons, or emergency rooms). A battery of 28 items covering eight domains of health (physical functioning, emotional well-being, role functioning, pain, general health perceptions, social functioning, energy, disability days) was administered. The eight domains were combined into physical and mental health summary scores. SF-36 physical functioning and emotional well-being scales were compared with the US general population and patients with other chronic diseases on a 0 to 100 scale. RESULTS: Physical functioning was about the same for adults with asymptomatic HIV disease as for the US population [mean (+/- SD) of 92 +/- 16 versus 90 +/- 17) but was much worse for those with symptomatic HIV disease (76 +/- 28) or who met criteria for the acquired immunodeficiency syndrome (AIDS; 58 +/- 31). Patients with AIDS had worse physical functioning than those with other chronic diseases (epilepsy, gastroesophageal reflux disease, clinically localized prostate cancer, clinical depression, diabetes) for which comparable data were available. Emotional well-being was comparable among patients with various stages of HIV disease (asymptomatic, 62 +/- 9; symptomatic, 59 +/- 11; AIDS, 59 +/- 11), but was significantly worse than the general population and patients with other chronic diseases except depression. In multivariate analyses, HIV-related symptoms were strongly associated with physical and mental health, whereas race, sex, health insurance status, disease stage, and CD4 count were at most weakly associated with physical and mental health. CONCLUSIONS: There is substantial morbidity associated with HIV disease in adults. The variability in health-related quality of life according to disease progression is relevant for health policy and allocation of resources, and merits the attention of clinicians who treat patients with HIV disease.

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