Persons living with HIV treated in acute HIV infection report good health-related quality of life in Thailand

ABSTRACT

The health-related quality of life (HRQoL) among persons living with HIV (PLWHA) who initiate ART during acute HIV infection (AHI) is not well studied. Participants in the SEARCH010/RV254 cohort initiated ART during AHI. They completed the Thai version of the World Health Organisation Quality of Life instrument-BREF (WHOQOL-BREF) and Patient Health Questionnaire-9 (PHQ-9) prior to ART initiation and 24 weeks later. Of 452 participants, 406 (90%) completed the WHOQOL-BREF. The median age was 26 years (IQR 22–31), and 98% were men. All WHOQOL-BREF domains demonstrated good internal consistency (Cronbach's alpha >0.70). Confirmatory factor analysis validated the WHOQOL-BREF model. 90% of Pearson correlations between domain scores and general facet items were >0.50. HRQoL in all domains was worse among those with at least moderately severe depression (PHQ-9 ≥ 10) (p<0.0001), supporting discriminant validity. At 24 weeks, there was an improvement of scores in all domains (physical, psychological, social, and environmental) and general facet items (p<0.0001), and the range of mean domain scores was 14.7–15.6 (SD 2.3–2.8). The majority of participants (58–63%) had improved HRQoL in the physical, psychological and environmental domains. It is concluded that HRQoL improves 6 months after initiation of ART in AHI, suggesting a benefit of early ART initiation.

KEYWORDS:

• HIV
• Asian
• patient reported outcome measures
• quality of life
• minimal clinically important difference
• highly active antiretroviral therapy

Acknowledgements

The study team is grateful to the individuals who participated in this study, the staff at the Thai Red Cross AIDS Research Centre and the Department of Retrovirology, U.S. Army Medical Component, Armed Forces Research Institute of Medical Sciences (AFRIMS). Viiv Healthcare provided abacavir, lamivudine, and dolutegrair for this study. Other antiretrovirals in the study were provided by the Thai Government Pharmaceutical Organisation, Gilead and Merck. The RV254/SEARCH 010 Study Group includes the following team members from SEARCH/TRC-ARC/HIV-NAT: Nipat Teeratakulpisarn, Supanit Pattanachaiwit, Mark de Souza, James Fletcher, Ponpen Tantivitayakul, Kultida Poltavee, Jintana Intasan, Tassanee Luekasemsuk, Hathairat Savadsuk, Somporn Tipsuk, Suwanna Puttamsawin, Khunthalee Benjapornpong, Nisakorn Ratnaratorn, Kamonkan Tangnaree, Chutharat Munkong, Rommanus Thaimanee, Patcharin Eamyoung, Sasiwimol Ubolyam; from AFRIMS: Robert O’Connell, Alexandra Schuetz, Denise Hsu, Tanyaporn Wansom, Siriwat Akapirat, Bessara Nuntapinit, Nantana Tantibul, Nampueng Churikanont, Saowanit Getchalarat; MHRP: Nelson Michael, Trevor Crowell, Ellen Turk, Corinne McCullough, Oratai Butterworth, Madelaine Ouelette, Mark Milazzo, Leigh Anne Eller.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclaimer

The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above, the U.S. Department of the Army or the U.S. Department of Defence, the National Institutes of Health, the Department of Health and Human Services, or the United States government, nor does mention of trade names, commercial products, or organisations imply endorsement by the Thai Red Cross AIDS Research Centre. The investigators have adhered to the policies for protection of human subjects as prescribed in AR-70-25.

Competing interests

JA has received honoraria for participating in advisory meetings for ViiV Healthcare, Gilead, Merck, Roche and AbbVie. Other authors declare no conflict of interest.

Authors’ contributions

OG and TC conceived the study. OG, EK, CS, PC, NP, and DC participated in study coordination, laboratory testing, and clinical care of participants. RK compiled the data. OG, EK, CS, PC, NP, AW, JA, SV and DC participated in the study design and data interpretation. OG led the study, performed statistical analysis, and wrote the first draft of the article. OG and DC drafted the final article. All authors included read, provided input in the article, and approved the final article.

Additional information

Funding

The study was funded under a cooperative agreement (WW81XWH-18-2-0040) between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense (DOD) and by the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institute of Health (DAIDS NIAID NIH) (grant AAI20052001). Antiretroviral therapy was supported by the Thai Government Pharmaceutical Organization, Gilead, Merck and ViiV Healthcare.