Impacts of HIV infection and HAART use on quality of life

Background: Studies have shown the detrimental effect of HIV disease on quality of life (QOL). Changes in QOL related to the use of highly active antiretroviral therapy (HAART) have been inconsistent and it is unknown how QOL after HAART compares to pre-infection levels. Objective: The objective of this study was to determine the impacts of becoming HIV infected and using HAART on QOL within individuals followed in the Multicenter AIDS Cohort Study (MACS). Methods: Using the standard Medical Outcome Study SF-36 form, QOL data were collected pre-seroconversion, post-seroconversion but before HAART initiation, and after HAART initiation for 68 seroconverters. The QOL physical health summary score (PHS) and mental health summary score (MHS) were used as outcomes. The effects of HIV infection and HAART use on QOL summary scores were determined using random effects mixed linear models after controlling for possible confounders. The clinical significance of QOL change was assessed using the Cohen's effect size method. Results: Compared to pre-seroconversion values, the PHS decreased after seroconversion (mean difference (diff) = -1.62; 95% confidence interval (CI): [-3.20, -0.03]) and after HAART initiation (diff = -4.20; 95% CI: [-5.86, -2.54]) with small to medium effect sizes. The score remained significantly lower than prior to HIV infection (diff = -6.16; 95% CI: [-8.09, -4.23]) after being on HAART for more than 4 years. The MHS did not significantly differ upon seroconversion (diff = -1.16; 95% CI: [-3.32, 1.00]). After using HAART for more than 4 years, the MHS was significantly greater than prior to HIV infection (diff = 2.93; 95% CI: [0.31, 5.55]) with a small effect size. Conclusion: The QOL of participants has been dynamic over the HIV disease course. HIV infection deteriorated physical but not mental QOL. In this group, although the PHS following HAART has remained lower than that prior to infection, HAART has enhanced mental health functioning.