Objectives

To determine long-term predictors of health-related quality of life (HRQOL) and evaluate the treatment effect of highly active antiretroviral therapy (HAART) on HRQOL in the US Military HIV Natural History Study (NHS) cohort.

Methods

Participants were a nested cohort of the NHS who responded to the Rand Short Form 36 questionnaire administered from 2006 to 2010. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed using standard algorithms. HAART-status was categorized as non-protease inhibitor-based (NPI-HAART), protease inhibitor-based (PI-HAART), HAART-naïve, or off-HAART. Mixed linear random effects models were used to estimate changes in PCS and MCS over time for treatment and covariates (including CD4 count, HIV viral load, medical and mental comorbidities).

Results

Eight hundred and twelve participants met the inclusion criteria. There was no difference in PCS or MCS between those on PI-HAART compared to NPI-HAART. Significant predictors of PCS were CD4 count < 200 cells/mm³ (β = − 2.90), CD4 count 200–499 cells/mm³ (β = − 0.80), and mental comorbidity (β = − 3.23). Others were medical comorbidity, AIDS-defining illness, being on NPI-HAART, HAART-naïve, age, and rank. Those with medical comorbidities experienced yearly improvement in PCS. Predictors of MCS were CD4 count < 200 cells/mm³ (β = − 2.53), mental comorbidity (β = − 4.58), and being African American (β = 2.59).

Conclusion

HRQOL was significantly affected by low CD4 count, medical and mental comorbidities. Addressing these modifiable factors would be expected to improve the physical and mental HRQOL of the cohort. Our study did not find any treatment benefit of NPI-HAART over PI-HAART on HRQOL in the long term.

中文翻译：

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军事艾滋病毒感染者中与健康有关的生活质量的预测指标。

目标

要确定与健康相关的生活质量（HRQOL）的长期预测指标，并在美国军事HIV自然史研究（NHS）队列中评估高活性抗逆转录病毒疗法（HAART）对HRQOL的治疗效果。

方法

参与者是NHS的一个嵌套队列，他们对2006年至2010年间执行的Rand Short Form 36问卷进行了答复。使用标准算法计算了身体成分总分（PCS）和心理成分总分（MCS）。HAART的状态分为基于非蛋白酶抑制剂的（NPI-HAART），基于蛋白酶抑制剂的（PI-HAART），未经HAART或非HAART。混合线性随机效应模型用于估计治疗和协变量（包括CD4计数，HIV病毒载量，医疗和精神合并症）随时间推移PCS和MCS的变化。

结果

812名参与者符合入选标准。与NPI-HAART相比，PI-HAART上的PCS或MCS没有差异。PCS的重要预测指标是CD4计数<200个细胞/ mm ³（β  =-2.90），CD4计数200-499个细胞/ mm ³（β  =-0.80）和精神合并症（β  =-3.23）。其他疾病包括医学合并症，定义艾滋病的疾病，NPI-HAART，HAART天真，年龄和等级。患有医疗合并症的患者PCS逐年改善。MCS的预测指标为CD4计数<200细胞/ mm ³（β  = − 2.53），精神合并症（β  = − 4.58）和非裔美国人（β = 2.59）。

结论

CD4计数低，医疗和精神疾病合并症严重影响了HRQOL。解决这些可修改的因素将有望改善该队列的身心HRQOL。我们的研究没有发现NPI-HAART在HRQOL方面比PI-HAART有任何治疗益处。