Préau Marie, Marcellin Fabienne, Carrieri Marie Patrizia, Lert France, Obadia Yolande, Spire Bruno
1 INSERM Research Unit 379 Epidemiology and Social Sciences Applied to Medical Innovation, Marseille, France.
AIDS. 2007 Jan;21 Suppl 1:S19-27. doi: 10.1097/01.aids.0000255081.24105.d7.
Since the advent of HAART, the assessment of health-related quality of life (HRQL) has become a major concern in the therapeutic follow-up of people living with HIV.
HRQL was evaluated for 2235 participants in the ANRS-EN12-VESPA Study. These participants completed the Medical Outcome Study 36-Item Short Form Health Survey (MOS SF-36) questionnaire. Anxiety and depression were assessed using the Hospital Anxiety and Depression (HAD) scale. Individuals were considered to have an 'acceptable' physical (and mental) HRQL if their MOS SF-36 scores were greater than the 25 percentile of the corresponding age-sex-specific distribution of scores in the French general population.
Logistic regression models were used to identify factors associated with an 'acceptable' physical and mental HRQL among demographic, psychosocial and clinical characteristics. Potential selection bias caused by non-random missing responses to the MOS SF-36 questionnaire was statistically tested.
Physical and mental HRQL were 'acceptable' in 1176 (53%) and 1152 (51%) individuals, respectively. After adjusting for sociodemographic factors, HIV clinical status and hepatitis C co-infection, high HAD scores and the consumption of anxiolytic, antidepressant and hypnotic drugs were found to be negatively associated with normal physical and mental HRQL.
The role of disclosure and discrimination is determinant in HRQL, and the various cultural and psychological dimensions require further research. The presence of other infections or co-morbidities requires a comprehensive care system including medical staff and social worker teams. HIV should increasingly be regarded as a chronic disease characterized by different pathological conditions requiring a comprehensive and multidisciplinary approach.
自高效抗逆转录病毒治疗（HAART）出现以来，与健康相关的生活质量（HRQL）评估已成为HIV感染者治疗随访中的一个主要关注点。
在ANRS-EN12-VESPA研究中对2235名参与者的HRQL进行了评估。这些参与者完成了医学结局研究36项简短健康调查（MOS SF-36）问卷。使用医院焦虑和抑郁（HAD）量表评估焦虑和抑郁情况。如果个体的MOS SF-36得分高于法国普通人群相应年龄-性别特定得分分布的第25百分位数，则认为其身体（和心理）HRQL“可接受”。
使用逻辑回归模型来确定在人口统计学、心理社会和临床特征中与“可接受”的身体和心理HRQL相关的因素。对MOS SF-36问卷非随机缺失回答导致的潜在选择偏倚进行了统计学检验。
分别有1176名（53%）和1152名（51%）个体的身体和心理HRQL“可接受”。在调整了社会人口学因素、HIV临床状态和丙型肝炎合并感染后，发现HAD高分以及使用抗焦虑药、抗抑郁药和催眠药与正常的身体和心理HRQL呈负相关。
信息披露和歧视的作用在HRQL中起决定性作用，各种文化和心理层面需要进一步研究。其他感染或合并症的存在需要一个包括医务人员和社会工作团队的综合护理系统。HIV应越来越多地被视为一种以不同病理状况为特征的慢性病，需要综合和多学科的方法。
