Quality of life among people living with HIV: an evaluation of methodological issues and independent effects of age and gender on changes over time

Abstract

Current HIV treatments extend life expectancy for people living with HIV (PLWH), shifting focus to quality of life (QOL). QOL is a primary focus of healthcare and public health and is a key reason people access care. Low QOL can lead to poor health outcomes and low retention in care for PLWH, but recent research on factors impacting long-term changes in QOL among PLWH is limited. Age and gender in particular may differentially impact QOL. Determining their effects on QOL is important as targeted clinical approaches could be adopted to address low QOL in these populations. This study utilized data from 1225 HIV-positive participants from the SMART clinical trial followed for up to 60 months and employed longitudinal hierarchical mixed effects models. Participants 50 years and older had lower physical QOL over time (2.41 points lower, 95% CI: -3.34, -1.48; p<0.0001) compared to younger participants; this difference was statistically significant regardless of how age was modeled. Participants 50 years and older had lower physical QOL at baseline and this difference persisted over time but no evidence of a differential rate of change in physical QOL over time by age was found. Participants 50 years and older had higher mental QOL over time (0.92 points higher, 95% CI: 0.12, 1.71; p=0.0239) compared to younger participants; this difference was also statistically significant when age was modeled in 10 year categories or continuously but not when modeled in quintiles. Participants 50 years and older had slighter higher mental QOL at baseline and this difference persisted over time but no evidence of a differential rate of change in mental QOL over time by age was found. Men had higher physical QOL (1.54 points higher, 95% CI: 0.32, 2.76; p=0.0131) and mental QOL over time (1.84 points higher, 95% CI: 0.79, 2.88; p=0.0006) compared to women. Men had higher physical and mental QOL at baseline and this difference persisted over time but no evidence of a differential rate of change in physical QOL over time by gender was found. A sensitivity analysis using data from only SMART trial participants who were on continuous treatment through the study and another sensitivity analysis using multiple-imputation for missing data did not substantially alter these conclusions. Additional covariates associated with baseline QOL were income, race/ethnicity, current smoking, hepatitis C co-infection, prior serious non-AIDS event, diabetes, and body mass index (BMI). QOL was measured using the SF-12 which was found to be a reliable measure of QOL in this study population. This study was one of the first to use systematically collected QOL data with long follow-up to analyze the independent effects of age and gender on QOL changes among PLWH. Despite statistically significant differences results do not suggest that age and gender are primary drivers of declining QOL. Exploratory analyses identified income, smoking, hepatitis C co-infection, diabetes, and BMI as potential factors contributing to poor QOL and may be factors to drive future hypotheses about populations most at risk for poor or declining QOL over time.