Background

The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative people. However, little is known about how these populations compare in terms of health-related quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and South Africa.

Methods

As part of the HPTN 071 (PopART) study, data from adults aged 18–44 years were gathered between Nov 28, 2013, and March 31, 2015, in large cross-sectional surveys of random samples of the general population in 21 communities in Zambia and South Africa. HRQoL data were collected with a standardised generic measure of health across five domains. We used β-distributed multivariable models to analyse differences in HRQoL scores between HIV-negative and HIV-positive individuals who were unaware of their status; aware, but not in HIV care; in HIV care, but who had not initiated ART; on ART for less than 5 years; and on ART for 5 years or more. We included controls for sociodemographic variables, herpes simplex virus type-2 status, and recreational drug use.

Findings

We obtained data for 19 750 respondents in Zambia and 18 941 respondents in South Africa. Laboratory-confirmed HIV status was available for 19 330 respondents in Zambia and 18 004 respondents in South Africa; 4128 (21%) of these 19 330 respondents in Zambia and 4012 (22%) of 18 004 respondents in South Africa had laboratory-confirmed HIV. We obtained complete HRQoL information for 19 637 respondents in Zambia and 18 429 respondents in South Africa. HRQoL scores did not differ significantly between individuals who had initiated ART more than 5 years previously and HIV-negative individuals, neither in Zambia (change in mean score −0·002, 95% CI −0·01 to 0·001; p=0·219) nor in South Africa (0·000, −0·002 to 0·003; p=0·939). However, scores did differ between HIV-positive individuals who had initiated ART less than 5 years previously and HIV-negative individuals in Zambia (−0·006, 95% CI −0·008 to −0·003; p<0·0001). A large proportion of people with clinically confirmed HIV were unaware of being HIV-positive (1768 [43%] of 4128 people in Zambia and 2026 [50%] of 4012 people in South Africa) and reported good HRQoL, with no significant differences from that of HIV-negative people (change in mean HRQoL score −0·001, 95% CI −0·003 to 0·001, p=0·216; and 0·001, −0·001 to 0·001, p=0·997, respectively). In South Africa, HRQoL scores were lower in HIV-positive individuals who were aware of their status but not enrolled in HIV care (change in mean HRQoL −0·004, 95% CI −0·01 to −0·001; p=0·010) and those in HIV care but not on ART (−0·008, −0·01 to −0·004; p=0·001) than in HIV-negative people, but the magnitudes of difference were small.

Interpretation

ART is successful in helping to reduce inequalities in HRQoL between HIV-positive and HIV-negative individuals in this general population sample. These findings highlight the importance of improving awareness of HIV status and expanding ART to prevent losses in HRQoL that occur with untreated HIV progression. The gains in HRQoL after individuals initiate ART could be substantial when scaled up to the population level.

Funding

National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, National Institute of Mental Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, the Bill & Melinda Gates Foundation.

中文翻译：

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赞比亚和南非的HIV阳性和HIV阴性人群健康相关的生活质量差异：HPTN 071（PopART）试验的横断面基线调查

背景

接受抗逆转录病毒疗法（ART）的HIV阳性个体的预期寿命正在接近HIV阴性人群的预期寿命。但是，人们对这些人群在健康相关生活质量（HRQoL）方面的比较知之甚少。我们旨在比较赞比亚和南非的HIV阳性和HIV阴性人群的HRQoL。

方法

作为HPTN 071（PopART）研究的一部分，在2013年11月28日至2015年3月31日期间，收集了18-44岁成年人的数据，这些数据是对21个社区普通人口的随机样本进行的大型横断面调查。赞比亚和南非。HRQoL数据是通过五个领域的标准化通用健康衡量标准收集的。我们使用β分布的多变量模型来分析不知道其状态的HIV阴性和HIV阳性个体之间HRQoL得分的差异。意识到，但不是在艾滋病毒保健方面；在艾滋病毒治疗中，但尚未发起抗逆转录病毒疗法的人；使用ART的时间少于5年；并且在ART上使用5年或更长时间。我们纳入了社会人口统计学变量，单纯疱疹病毒2型状态和娱乐性毒品使用的控制。

发现

我们获得了赞比亚19 750名受访者和南非18 941名受访者的数据。赞比亚有19 330名被调查者和南非有18 004名被调查者获得了实验室确认的艾滋病毒状况；在赞比亚的19 330名受访者中，有4128名（21％）和在南非的18004名受访者中有4012名（22％）患有实验室确诊的艾滋病毒。我们获得了赞比亚19 637名受访者和南非18 429名受访者的完整HRQoL信息。五年前开始抗病毒治疗的个体和HIV阴性个体之间的HRQoL得分差异均无统计学意义（赞比亚均没有变化（平均得分−0·002、95％CI −0·01至0·001； p = 0·219）或南非（0·000，-0·002至0·003； p = 0·939）。然而，在小于5年前开始抗病毒治疗的HIV阳性患者和赞比亚的HIV阴性患者之间的得分确实有所不同（-0·006，95％CI -0·008至-0·003； p <0·0001）。大部分经过临床确认的艾滋病毒感染者并未意识到自己是艾滋病毒阳性（赞比亚的4128人中有1768人[43％]，南非的4012人中有2026人[50％]）在HRQoL方面表现良好，与HIV阴性人群的平均水平（HRQoL得分平均变化−0·001，95％CI −0·003到0·001，p = 0·216; 0·001，-0·001到0·001，p分别为= 0·997）。在南非，知道自己的状况但未参加HIV护理的HIV阳性个体的HRQoL分数较低（平均HRQoL -0·004，95％CI -0·01变为−0·001； p = 0·010）和那些接受HIV护理但未接受抗逆转录病毒治疗的患者（-0·008，-0·01至-0·004；

解释

在该总体人群样本中，ART成功地帮助减少了HIV阳性和HIV阴性个体之间HRQoL的不平等。这些发现强调了提高对艾滋病毒状况的认识和扩大抗逆转录病毒疗法的重要性，以防止因未经治疗的艾滋病毒进展而导致的HRQoL下降。当个体开始进行抗逆转录病毒治疗时，如果按人群水平进行，HRQoL的增加可能是可观的。

资金

美国国家过敏和传染病研究所，美国药物滥用研究所，美国心理健康研究所，总统关于艾滋病救济的紧急计划，国际影响评估倡议，比尔和梅琳达·盖茨基金会。