Poor quality of life among untreated Thai and Cambodian children without severe HIV symptoms

Abstract

There are limited data on quality of life (QOL)1in untreated HIV-infected children who do not have severe HIV symptoms. Moreover, such data do not exist for Asian children. Poor QOL could be a factor in deciding if antiretroviral therapy (ART) should be initiated. Thai and Cambodian children (n=294), aged 1–11 years, naïve to ART, with mild to moderate HIV symptoms and CD4 15–24% were enrolled. Their caregivers completed the Pediatric AIDS Clinical Trials Group QOL questionnaire prior to ART commencement. Six QOL domains were assessed using transformed scores that ranged from 0 to 100. Higher QOL scores indicated better health. Mean age was 6.1 (SD 2.8) years, mean CD4 was 723 (SD 369) cells/mm³, 57% was female, and%CDC N:A:B was 2:63:35%. One-third knew their HIV diagnosis. Mean (SD) scores were 69.9 (17.6) for health perception, 64.5 (16.2) for physical resilience, 84.2 (15.6) for physical functioning, 77.9 (16.3) for psychosocial well-being, 74.7 (28.7) for social and role functioning, 90.0 (12.1) for health care utilization, and 87.4 (11.3) for symptoms domains. Children with CD4 counts above the 2008 World Health Organization (WHO) ART-initiation criteria (n=53) had higher scores in health perception and health care utilization than those with lower CD4 values. Younger children had poorer QOL than older children despite having similar mean CD4%. In conclusion, untreated Asian children without severe HIV symptoms had relatively low QOL scores compared to published reports in Western countries. Therapy initiation criteria by the WHO identified children with lower QOL scores to start ART; however, children who did not fit ART-initiation criteria and those who were younger also displayed poor QOL. QOL assessment should be considered in untreated children to inform decisions about when to initiate ART.

Keywords:

• children
• ART-naïve
• HIV
• quality of life
• Asian

Acknowledgements

The PREDICT study is sponsored by National Institute of Allergy and Infectious Disease (NIAID), Grant number U19 AI053741, Clinical trial.gov identification number NCT00234091. Antiretroviral drugs for PREDICT are provided by GlaxoSmithKline (AZT, 3TC), Boehringer Ingelheim (NVP), Merck (EFV), Abbott (RTV), and Roche (NFV). The study is partially funded by the National Research Council of Thailand. We are grateful to the children and their families for participating in PREDICT. We thank the PACTG for providing raw data from the P1009 study and the PREDICT investigators for their contribution to this study. We thank Associate Prof. Penninah Oberdorfer, MD, PhD, Division of Infectious Diseases, Department of Pediatric, Chiang Mai University for sharing the QOL analysis methods; Pitch Boonrak, HIV-NAT, for performing interim analysis of the first Pediatric workshop, Cape Town, South Africa 2009; Ronald Galbraith, Alexandra Grino, and Nneka Edwards-Jackson for English editing; Stephen Kerr and Prof. Matthew Law, Kirby Institute for Infection and Immunity in Society, the University of New South Wales (UNSW), Sydney, Australia, for being the statistical analysis supervisor. Neither the authors nor member's of the author's immediate families have a financial interest in or arrangement with any commercial organization that may have a direct interest in the subject matter of this article.

Notes

1. The preliminary analysis of this study was presented as a poster at the 1st International Workshop on HIV Pediatrics, Cape Town, South Africa, 17–18 July 2009 abstract entitled: Association of HIV immune suppression and quality of life among Thai and Cambodian antiretroviral therapy naïve HIV-infected children. AbstractP106.