Author:
Rautenberg Tamlyn A.,Ng Shu Kay,George Gavin,Moosa Mahomed-Yunus S.,McCluskey Suzanne M.,Gilbert Rebecca F.,Pillay Selvan,Aturinda Isaac,Ard Kevin L.,Muyindike Winnie R.,Musinguzi Nicholas,Masette Godfrey,Pillay Melendhran,Moodley Pravi,Brijkumar Jaysingh,Gandhi Rajesh T.,Johnson Brent,Sunpath Henry,Bwana Mwebesa B.,Marconi Vincent C.,Siedner Mark J.
Abstract
Abstract
Background
Antiretroviral treatment improves health related quality of life (HRQoL) of people with human immunodeficiency virus (PWH). However, one third initiating first-line treatment experience virological failure and the determinants of HRQoL in this key population are unknown. Our study aims to identify determinants of among PWH failing antiretroviral treatment in sub-Saharan Africa.
Methods
We analysed data from a cohort of PWH having virological failure (> 1,000 copies/mL) on first-line ART in South Africa and Uganda. We measured HRQoL using the EuroQOL EQ-5D-3L and used a two-part regression model to obtain by-country analyses for South Africa and Uganda. The first part identifies risk factors that were associated with the likelihood of participants reporting perfect health (utility = 1) versus non-perfect health (utility < 1). The second part identifies risk factors that were associated with the EQ-5 L-3L utility scores for participants reporting non-perfect health. We performed sensitivity analyses to compare the results between the two-part model using tobit models and ordinary least squares regression.
Results
In both countries, males were more likely to report perfect health and participants with at least one comorbidity were less likely to report perfect health. In South Africa, participants with side effects and in Uganda those with opportunistic infections were also less likely to report perfect health. In Uganda, participants with 100% ART adherence were more likely to report perfect health. In South Africa, high HIV viral load, experiencing ART side effects, and the presence of opportunistic infections were each associated with lower HRQoL, whereas participants with 100% ART adherence reported higher HRQoL. In Uganda participants with lower CD4 count had lower HRQoL.
Conclusion
Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure.
Trial registration
ClinicalTrials.gov: NCT02787499.
Funder
National Institutes of Health
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,General Medicine
Reference41 articles.
1. Marcus JL, Leyden WA, Alexeeff SE, Anderson AN, Hechter RC, Hu H, Infection HIV, et al. JAMA Netw open. 2020;3(6):2000–16.
2. Thomas R, Burger R, Harper A, Kanema S, Mwenge L, Vanqa N, et al. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial. The Lancet Global health. 2017;5(11):e1133–e41.
3. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents. Living with HIV [Available from: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf.
4. Bigna JJ, Plottel CS, Koulla-Shiro S. Challenges in initiating antiretroviral therapy for all HIV-infected people regardless of CD4 cell count. Infect Dis poverty. 2016;5(1):85.
5. Jamieson D, Kellerman SE. The 90 90 90 strategy to end the HIV pandemic by 2030: can the supply chain handle it? J Int AIDS Soc. 2016;19(1):20917.