Department of Health Psychology, University of Alicante, Alicante, Spain.
Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
AIDS Behav. 2024 Jun;28(6):1978-1998. doi: 10.1007/s10461-024-04298-y. Epub 2024 May 14.
The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: "health-related quality of life", "HQRoL", "HIV", "AIDS", "advanced HIV disease" and "low CD4 cells". Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case-control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.
本研究旨在评估晚期 HIV 疾病 (AHD) 对 HIV 感染者健康相关生活质量 (HRQoL) 的影响，分析过去 25 年来 HRQoL 结果的变化，以及根据经济发展水平国家之间的差异。我们进行了系统评价和荟萃分析。在 PubMed 和 Web of Science 中使用以下术语进行检索：“健康相关生活质量”、“HQRoL”、“HIV”、“AIDS”、“晚期 HIV 疾病”和“低 CD4 细胞”。研究纳入标准为：成人人群；1996 年后启动，2021 年 7 月前发表；临床试验、横断面、队列和病例对照研究；分析 AHD 与 HRQoL 之间关系的研究；英语或西班牙语。计算标准化均数差值（d+）来估计荟萃分析的效应量。使用随机效应模型计算汇总统计数据，并使用混合效应模型分析效应调节剂。荟萃分析纳入了 38 项研究。结果表明，与无 AHD 的患者相比，AHD 患者的 HRQoL 更差。受影响的主要 HRQoL 领域是整体健康感知和担忧以及身体和功能健康和症状。我们发现年龄和性别对某些 HRQoL 领域有中度影响。在社会经济不平等、居住国或分析时间段方面没有差异。结论：晚期 HIV 疾病对 HIV 感染者的健康和福祉有负面影响。我们的结果表明，尽管过去 25 年来抗逆转录病毒治疗取得了所有进展，但 AHD 仍然是一个极端脆弱的来源，无论 HIV 感染者居住在哪里。
