Immunological markers (CD4 count) are used in developing
countries to decide on initiation of antiretroviral therapy and monitor
HIV/AIDS disease progression. HIV is an incurable chronic illness, making
quality of life paramount. The direct relationship between quality of life and
CD4 count is unclear. The purpose of this study is to determine the
relationship between change in CD4 count and quality of life measures in a
Ugandan cohort of people living with HIV.
We prospectively assessed quality of life among 1274 HIV
patients attending an HIV clinic within a national referral hospital over a
period of 6 months. Quality of life was measured using an objective measure,
the Medical Outcomes Study HIV health survey summarized as Physical Health
Score and Mental Health Score and a subjective measure, the Global Person Generated
Index. Generalized estimating equations were used to analyze the data. The
primary predictor variable was change in CD4 count, and the outcome was quality
of life scores. We controlled for sociodemographic characteristics, clinical
factors and behavioral factors. Twenty in-depth interviews were conducted to
assess patient perception of quality of life and factors influencing quality of
life.
Of the 1274 patients enrolled 1159 had CD4 count at baseline
and six months and 586 (51%) received antiretroviral therapy. There was no
association found between change in CD4 count and quality of life scores at
univariate and multivariate analysis among the study participants whether on or
not on antiretroviral therapy. Participants perceived quality of life as
happiness and well-being, influenced by economic status, psychosocial factors,
and health status.
Clinicians and policy makers cannot rely on change in
immunological markers to predict quality of life in this era of initiating
antiretroviral therapy among relatively healthy patients. In addition to
monitoring immunological markers, socioeconomic and psychosocial factors should
be underscored in management of HIV patients.
By: Mwesigire DM1, Martin F2, Seeley J3, Katamba A4.
- 1Department of Medicine, Makerere College of Health Sciences, PO Box 7072, Kampala, Uganda.
- 2Department of Psychology, University of Bath, Bath, United Kingdom. psmfm@bath.ac.uk.
- 3MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda.
- 4Department of Medicine, Makerere College of Health Sciences, PO Box 7072, Kampala, Uganda
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