Gill Christopher J, Griffith John L, Jacobson Denise, Skinner Sarah, Gorbach Sherwood L, Wilson Ira B
Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts 02111, USA.
J Acquir Immune Defic Syndr. 2002 Aug 15;30(5):485-92. doi: 10.1097/00126334-200208150-00004.
To understand the relationship of viral load (VL), CD4 counts, and highly active antiretroviral therapy (HAART) use to health-related quality of life (HRQL).
Cross-sectional analysis of 513 HIV-infected patients. Primary outcomes were four domains of HRQL: physical functioning (PF), role function (RF), energy levels (EL), and health perceptions (HP). The authors examined univariate and multivariate relationships between VL, CD4, and HAART use to each HRQL domain, after adjustment for potential confounders.
In univariate analyses, compared with patients with CD4 > 500, those with CD4 < 200 (p =.001) or 200 to 500 (p =.002) had lower PF and RF scores, and patients with undetectable VL had higher PF scores than patients with VL log10 2.6 to 4.0 (p =.02) and > log10 4.0 (p =.01). In multivariate analyses, compared with patients with CD4 > 500, patients with CD4 < 200 had lower PF (-8.8 points; p <.01), RF (-9.3 points; p <.01), and HP (-7.8 points; p <.001). Patients with log10 VL 2.6 to 4.0 had lower PF scores (-7.7 points; p <.01) versus undetectable VL. After adjusting for VL and CD4 counts, HAART use was associated with lower PF scores (-5.4 points; p <.05).
Efforts to improve patients' CD4 counts are likely to also improve HRQL. Lowering viral loads may improve physical functioning, but only if VL are suppressed to undetectable levels. In this analysis, HAART had negative effects on PF that were independent of its effects on CD4 and VL. For adherent patients, these adverse effects of HAART on PF are likely to be outweighed by the positive effects that HAART exerts through lowering VL and increasing CD4 counts.
了解病毒载量（VL）、CD4细胞计数以及高效抗逆转录病毒治疗（HAART）的使用与健康相关生活质量（HRQL）之间的关系。
对513名HIV感染患者进行横断面分析。主要结局为HRQL的四个领域：身体功能（PF）、角色功能（RF）、能量水平（EL）和健康认知（HP）。在对潜在混杂因素进行调整后，作者研究了VL、CD4和HAART使用与每个HRQL领域之间的单变量和多变量关系。
在单变量分析中，与CD4>500的患者相比，CD4<200（p = 0.001）或200至500（p = 0.002）的患者PF和RF得分较低，VL检测不到的患者PF得分高于VL log10 2.6至4.0（p = 0.02）和> log10 4.0（p = 0.01）的患者。在多变量分析中，与CD4>500的患者相比，CD4<200的患者PF（-8.8分；p<0.01）、RF（-9.3分；p<0.01）和HP（-7.8分；p<0.001）较低。log10 VL 2.6至4.0的患者与VL检测不到的患者相比PF得分较低（-7.7分；p<0.01）。在调整VL和CD4细胞计数后，使用HAART与较低的PF得分相关（-5.4分；p<0.05）。
提高患者CD4细胞计数的努力可能也会改善HRQL。降低病毒载量可能会改善身体功能，但前提是VL被抑制到检测不到的水平。在本分析中，HAART对PF有负面影响，且独立于其对CD4和VL的影响。对于依从性好的患者，HAART对PF的这些不利影响可能会被HAART通过降低VL和增加CD4细胞计数所产生的积极影响所抵消。
