Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA.
Qual Life Res. 2020 Jul;29(7):1855-1869. doi: 10.1007/s11136-020-02441-5. Epub 2020 Feb 20.
To determine long-term predictors of health-related quality of life (HRQOL) and evaluate the treatment effect of highly active antiretroviral therapy (HAART) on HRQOL in the US Military HIV Natural History Study (NHS) cohort.
Participants were a nested cohort of the NHS who responded to the Rand Short Form 36 questionnaire administered from 2006 to 2010. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed using standard algorithms. HAART-status was categorized as non-protease inhibitor-based (NPI-HAART), protease inhibitor-based (PI-HAART), HAART-naïve, or off-HAART. Mixed linear random effects models were used to estimate changes in PCS and MCS over time for treatment and covariates (including CD4 count, HIV viral load, medical and mental comorbidities).
Eight hundred and twelve participants met the inclusion criteria. There was no difference in PCS or MCS between those on PI-HAART compared to NPI-HAART. Significant predictors of PCS were CD4 count < 200 cells/mm (β = - 2.90), CD4 count 200-499 cells/mm (β = - 0.80), and mental comorbidity (β = - 3.23). Others were medical comorbidity, AIDS-defining illness, being on NPI-HAART, HAART-naïve, age, and rank. Those with medical comorbidities experienced yearly improvement in PCS. Predictors of MCS were CD4 count < 200 cells/mm (β = - 2.53), mental comorbidity (β = - 4.58), and being African American (β = 2.59).
HRQOL was significantly affected by low CD4 count, medical and mental comorbidities. Addressing these modifiable factors would be expected to improve the physical and mental HRQOL of the cohort. Our study did not find any treatment benefit of NPI-HAART over PI-HAART on HRQOL in the long term.
确定与健康相关的生活质量（HRQOL）的长期预测因素，并评估高效抗逆转录病毒疗法（HAART）对美国军事艾滋病毒自然史研究（NHS）队列 HRQOL 的治疗效果。
参与者是 NHS 的嵌套队列，他们对 2006 年至 2010 年期间管理的 Rand 短期表格 36 问卷做出了回应。使用标准算法计算生理成分综合评分（PCS）和心理成分综合评分（MCS）。HAART 状况分为非蛋白酶抑制剂（NPI-HAART）、蛋白酶抑制剂（PI-HAART）、HAART 初治和脱 HAART。混合线性随机效应模型用于估计治疗和协变量（包括 CD4 计数、HIV 病毒载量、医疗和精神合并症）随时间变化时 PCS 和 MCS 的变化。
812 名参与者符合纳入标准。与 NPI-HAART 相比，PI-HAART 组的 PCS 或 MCS 没有差异。PCS 的显著预测因素包括 CD4 计数<200 个细胞/mm（β=-2.90）、CD4 计数 200-499 个细胞/mm（β=-0.80）和精神合并症（β=-3.23）。其他因素包括医疗合并症、艾滋病定义性疾病、NPI-HAART、HAART 初治、年龄和职级。患有医疗合并症的患者每年 PCS 都会有所改善。MCS 的预测因素包括 CD4 计数<200 个细胞/mm（β=-2.53）、精神合并症（β=-4.58）和非裔美国人（β=2.59）。
HRQOL 受到 CD4 计数低、医疗和精神合并症的显著影响。解决这些可改变的因素有望提高队列的身体和心理健康 HRQOL。我们的研究没有发现 NPI-HAART 在长期内对 PI-HAART 对 HRQOL 的治疗有任何益处。
