HIV and health-related quality-of-life in the UK - where are we now?

Background: Little is known about health-related quality-of-life (HRQoL) among people living with HIV in the era of combination antiretroviral therapy (cART), compared to the general population (GenPop). It is also unclear whether HRQoL decreases more quickly with increasing age in people with HIV. This study assesses these two issues. Methods: Data from two (2011-12) UK cross sectional studies were used. ASTRA, containing an unselected sample of people diagnosed with HIV attending outpatient clinics (n = 3,258) and the Health Survey for England (n = 8,503). HRQoL was assessed using the EQ5D-3L utility instrument (utilities of 0 and 1 equal to perfect health and death respectively). EQ5D-3L includes mobility, self-care, usual activities, pain and anxiety / depression. Multivariable analyses compared HRQoL between the two samples, using two part regression modelling (TPM). Different categorisations of HIV infection were used in four models (1) HIV versus GenPop; (2) HIV sample split by CD4 count c/mm 3 (≤200 / >200); (3) HIV sample split by ART status/viral load (on cART VL≤50 c/mL, on cART VL≤50 c/mL, never cART, stopped cART). All models were adjusted for age and gender; 2 and 3 were also adjusted for socioeconomic variables. In a 4 th model, an interaction term between HIV and age was included. Results: HRQoL was lower for those with HIV compared to GenPop for all EQ5D-3L domains but particularly anxiety / depression, with a 24% absolute difference in the proportion with at least ‘some problems’. The TPM’s showed that people with HIV had significantly lower scores compared to the GenPop (difference for model 1: 0.11; 95% CI 0.10 to 0.13). Differences remained significant after adjusting for socioeconomic variables, and were apparent across all CD4 and ART/VL categories (models 2 and 3). Female gender, non- white ethnicity, not having children, smoking and lower education were also associated with lower HRQoL. The effect of HIV on HRQoL was of a similar magnitude to heavy smoking. There was no interaction between age and HIV status (p = 0.70). Conclusion: People living with HIV have significantly reduced HRQoL compared to GenPop levels, despite the majority being virologically and immunologically stable. This may be due to HIV itself or other factors. There was no evidence of a greater effect of ‘ageing’ effect on HRQoL for those with HIV. This study provides evidence on the ‘value’ of preventing further HIV infections, particularly for future cost-effectiveness analyses.