Top

Health and Quality of Life Outcomes

Published in:

Open Access 01-12-2015 | Research

Relationship between CD4 count and quality of life over time among HIV patients in Uganda: a cohort study

Authors: Doris Mutabazi Mwesigire, Faith Martin, Janet Seeley, Achilles Katamba

Published in: Health and Quality of Life Outcomes | Issue 1/2015

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Mellors JW, Munoz A, Giorgi JV, Margolick JB, Tassoni CJ, Gupta P, et al. Plasma Viral Load and CD4+ Lymphocytes as Prognostic Markers of HIV-1 Infection. Ann Intern Med. 1997;126(12):946–54.CrossRefPubMed

O'Brien WA, Hartigan PM, Martin D, Esinhart J, Hill A, Benoit S, et al. Changes in Plasma HIV-1 RNA and CD4+ Lymphocyte Counts and the Risk of Progression to AIDS. N Engl J Med. 1996;334(7):426–31. doi:10.1056/NEJM199602153340703.CrossRefPubMed

MacArthur R, Perez G, Walmsley S, Baxter J, Mullin C, Neaton J, et al. Comparison of prognostic importance of latest CD4+ cell count and HIV RNA levels in patients with advanced HIV infection on highly active antiretroviral therapy. HIV Clin Trials. 2005;6(3):127–35.CrossRefPubMed

Wu AW. Quality of life assessment comes of age in the era of highly active antiretroviral therapy. AIDS. 2000;14(10):1449–51.CrossRefPubMed

Murri R, Fantoni M, Del Borgo C, Visona R, Barracco A, Zambelli A, et al. Determinants of health-related quality of life in HIV-infected patients. AIDS Care. 2003;15(4):581–90. doi:10.1080/0954012031000134818.CrossRefPubMed

Stangl AL, Wamai N, Mermin J, Awor AC, Bunnell RE. Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda. AIDS Care. 2007;19(5):626–36. doi:10.1080/09540120701203915.CrossRefPubMed

Sekabira R, Nankya-Mutyoba J, Makumbi F, Kiwanuka N, Kiweewa F, Wambwire Mangen F. Determinants of Health-Related Quality of Life among Adults in Routine HIV Care. 2012;1:515. doi:104172/scientificreports515.

Jelsma J, MacLean E, Hughes J, Tinise X, Darder M. An investigation into the health-related quality of life of individuals living with HIV who are receiving HAART. AIDS Care. 2005;17(5):579–88. doi:10.1080/09540120412331319714.CrossRefPubMed

Bajunirwe F, Tisch DJ, King CH, Arts EJ, Debanne SM, Sethi AK. Quality of life and social support among patients receiving antiretroviral therapy in Western Uganda. AIDS Care. 2009;21(3):271–9. doi:10.1080/09540120802241863.CrossRefPubMed

10.

Briongos Figuero LS, Bachiller Luque P, Palacios Martín T, González Sagrado M, Eiros Bouza JM. Assessment of factors influencing health-related quality of life in HIV-infected patients. HIV Med. 2011;12(1):22–30. doi:10.1111/j.1468-1293.2010.00844.x.CrossRefPubMed

11.

Akinboro AO, Akinyemi SO, Olaitan PB, Raji AA, Popoola AA, Awoyemi OR, et al. Quality of life of Nigerians living with human immunodeficiency virus. Pan Afr Med J. 2014;18:234. doi:10.11604/pamj.2014.18.234.2816.PubMedCentralCrossRefPubMed

12.

Harding R, Simms V, Penfold S, Downing J, Namisango E, Powell RA, et al. Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study. BMC Infect Dis. 2014;14:613. doi:10.1186/s12879-014-0613-1.PubMedCentralCrossRefPubMed

13.

Nglazi M, West S, Dave J, Levitt N, Lambert E. Quality of life in individuals living with HIV/AIDS attending a public sector antiretroviral service in Cape Town. BMC Public Health. 2014;14(1):676.PubMedCentralCrossRefPubMed

14.

Jia H, Uphold RC, Wu S, Chen GJ, Duncan WP. Predictors of Changes in Health-Related Quality of Life Among Men with HIV Infection in the HAART Era. AIDS Patient Care STDS. 2005;19(6):395–405.CrossRefPubMed

15.

Gill C, Griffith J, Jacobson D, Skinner S, Gorbach S, Wilson I. Relationship of HIV viral loads, CD4 counts, and HAART use to health-related quality of life. J Acquir Immune Defic Syndr. 2002;15(5):485–92.CrossRef

16.

Weinfurt KP, Willke RJ, Glick HA, Freimuth WW, Schulman KA. Relationship Between CD4 Count, Viral Burden, and Quality of Life Over Time in HIV-1-Infected Patients. Med Care. 2000;38(4):404–10.CrossRefPubMed

17.

Igumbor J, Stewart A, Holzemer W. Comparison of the health-related quality of life, CD4 count and viral load of AIDS patients and people with HIV who have been on treatment for 12 months in rural South Africa. SAHARA J. 2013;10(1):25–31.PubMedCentralPubMed

18.

Venter E, Gerike G, Bekker P. Nutritional status, quality of life and CD4 cell count of adults living with HIV/AIDS in the Ga-Rankuwa area (South Africa). S Afr J Clin Nutr. 2009;22(3):124–9.

19.

Bucciardini R, Pugliese K, Weimer L, Digregorio M, Fragola V, Mancini M, et al. Relationship Between Health-Related Quality of Life Measures and High HIV Viral Load in HIV-Infected Triple-Class-Experienced Patients. HIV Clin Trials. 2014;15(4):176–83. doi:10.1310/hct1504-176.CrossRefPubMed

20.

Magafu M, Moji K, Igumbor E, Hashizume M, Mizota T, Komazawa O, et al. Usefulness of highly active antiretroviral therapy on health-related quality of life of adult recipients in Tanzania. AIDS Patient Care STDS. 2009;23(7):563–70.CrossRefPubMed

21.

Arpinelli F, Visonà G, Bruno R, De Carli G, Apolone G. Health-related quality of life in asymptomatic patients with HIV. Evaluation of the SF-36 health survey in Italian patients. Pharmacoeconomics. 2000;18(1):63–72.CrossRefPubMed

22.

Chandra P, Gandhi C, Satishchandra P, Kamat A, Desai A, Ravi V, et al. Quality of life in HIV subtype C infection among asymptomatic subjects and its association with CD4 counts and viral loads – a study from South India. Qual Life Res. 2006;15(10):1597–605. doi:10.1007/s11136-006-9001-7.CrossRefPubMed

23.

Jia H, Uphold C, Zheng Y, Wu S, Chen GJ, Findley K, et al. A further investigation of health-related quality of life over time among men with HIV infection in the HAART era. Qual Life Res. 2007;16(6):961–8. doi:10.1007/s11136-007-9214-4.CrossRefPubMed

24.

Call SA, Klapow JC, Stewart KE, Westfall AO, Mallinger AP, DeMasi RA, et al. Health-related Quality of Life and Virologic outcomes in an HIV Clinic. Qual Life Res. 2000;9(9):977–85. doi:10.1023/a:1016668802328.CrossRefPubMed

25.

WHO. Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents. 2010.

26.

Mutabazi-Mwesigire D, Seeley J, Martin F, Katamba A. Perceptions of quality of life among Ugandan patients living with HIV: a qualitative study. BMC Public Health. 2014;14(1):343.PubMedCentralCrossRefPubMed

27.

Martin F, Camfield L, Ruta DA, editors. Handbook of Disease Burdens and Quality of Life measure. The Global Person Generated Index. New York: Springer; 2009.

28.

Wu AW, Rubin HR, Mathews WC, Ware Jr JE, Brysk LT, Hardy WD, et al. A Health Status Questionnaire Using 30 Items from the Medical Outcomes Study. Med Care. 1991;29(8):786–98. doi:10.2307/3766106.CrossRefPubMed

29.

Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for Reliability, Validity and Usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Qual Life Res. 1997;6(6):481–93. doi:10.2307/4034708.CrossRefPubMed

30.

Stangl A, Bunnell R, Wamai N, Masaba H, Mermin J. Measuring quality of life in rural Uganda: reliability and validity of summary scores from the Medical Outcomes Study HIV Health Survey (MOS-HIV). Qual Life Res. 2012;21(9):1655–63. doi:10.1007/s11136-011-0075-5.CrossRefPubMed

31.

Mast CT, Kigozi G, Wabwire-mangen F, Black R, Sewankambo N, Serwadda D, et al. Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district. Uganda AIDS Care. 2004;16(1):81–94. doi:10.1080/09540120310001633994.CrossRefPubMed

32.

Smith MY, Feldman J, Kelly P, DeHovitz JA, Chirgwin K, Minkoff H. Health-related quality of life of HIV-infected women: evidence for the reliability, validity and responsiveness of the Medical Outcomes Study Short-Form 20. Qual Life Res. 1996;5(1):47–55. doi:10.1007/bf00435968.CrossRefPubMed

33.

Revicki DA, Sorensen S, Wu AW. Reliability and Validity of Physical and Mental Health Summary Scores from the Medical Outcomes Study HIV Health Survey. Med Care. 1998;36(2):126–37.CrossRefPubMed

34.

Martin F, Rodham K, Camfield L, Ruta D. Reliability and Validity of the Thai “Global Person Generated Index”, an Individualised Measure of Quality of Life. Appl Res Qual Life. 2010;5(3):219–32. doi:10.1007/s11482-010-9106-6.CrossRef

35.

Ruta DA, Garratt AM, Leng M, Russell IT, MacDonald LM. A New Approach to the Measurement of Quality of Life: The Patient-Generated Index. Med Care. 1994;32(11):1109–26.CrossRefPubMed

36.

Cummins R. The Second Approximation to an International Standard for Life Satisfaction. Social Indic Res. 1998;43(3):307–34. doi:10.1023/a:1006831107052.CrossRef

37.

Radloff L. The CES-D scale: s self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef

38.

Nakasujja N, Skolasky RL, Musisi S, Allebeck P, Robertson K, Ronald A, et al. Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda. BMC Psychiatry. 2010;10(1):44.PubMedCentralCrossRefPubMed

39.

Kaharuza F, Bunnell R, Moss S, Purcell D, Bikaako-Kajura W, Wamai N, et al. Depression and CD4 Cell Count Among Persons with HIV Infection in Uganda. AIDS Behav. 2006;10(1):105–11. doi:10.1007/s10461-006-9142-2.CrossRef

40.

Ewing JA. CAGE questionnaire allows doctors to avoid focusing on specifics of drinking. BMJ. 1998;316(7147):1827.PubMedCentralCrossRefPubMed

41.

O’Brien CP. The cage questionnaire for detection of alcoholism. JAMA. 2008;300(17):2054–6.CrossRefPubMed

42.

Oyugi JH, Byakika-Tusiime J, Charlebois ED, Kityo C, Mugerwa R, Mugyenyi P, et al. Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting. J Acquir Immune Defic Syndr. 2004;36(5):1100–2.CrossRefPubMed

43.

Sangeda R, Mosha F, Prosperi M, Aboud S, Vercauteren J, Camacho R, et al. Pharmacy refill adherence outperforms self-reported methods in predicting HIV therapy outcome in resource-limited settings. BMC Public Health. 2014;14(1):1035.PubMedCentralCrossRefPubMed

44.

Arnsten JH, Demas PA, Farzadegan H, Grant RW, Gourevitch MN, Chang C-J, et al. Antiretroviral Therapy Adherence and Viral Suppression in HIV-Infected Drug Users: Comparison of Self-Report and Electronic Monitoring. Clin Infect Dis. 2001;33(8):1417–23. doi:10.1086/323201.PubMedCentralCrossRefPubMed

45.

Samsa G, Edelman D, Rothman M, Williams GR, Lipscomb J, Matchar D. Determining Clinically Important Differences in Health Status Measures. Pharmacoeconomics. 1999;15(2):141–55. doi:10.2165/00019053-199915020-00003.CrossRefPubMed

46.

Deribew A, Tesfaye M, Hailmichael Y, Negussu N, Daba S, Wogi A, et al. Tuberculosis and HIV co-infection: its impact on quality of life. Health Qual Life Outcomes. 2009;7(1):105.PubMedCentralCrossRefPubMed

47.

Campsmith M, Nakashima A, Davidson A. Self-reported health-related quality of life in persons with HIV infection: results from a multi-site interview project. Health Qual Life Outcomes. 2003;1(1):12.PubMedCentralCrossRefPubMed

48.

Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53. doi:10.1080/09540120802511877.CrossRefPubMed

49.

Tesfay A, Gebremariam A, Gerbaba M, Abrha H. Gender Differences in Health Related Quality of Life among People Living with HIV on Highly Active Antiretroviral Therapy in Mekelle Town, Northern Ethiopia. Biomed Res Int. 2015;2015:9. doi:10.1155/2015/516369.CrossRef

50.

Patel R, Kassaye S, Gore-Felton C, Wyshak G, Kadzirange G, Woelk G, et al. Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe. AIDS Care. 2009;21(12):1517–27. doi:10.1080/09540120902923055.PubMedCentralCrossRefPubMed

51.

Seeley J, Russell S. Social rebirth and social transformation? Rebuilding social lives after ART in rural Uganda. AIDS Care. 2010;22(sup1):44–50. doi:10.1080/09540121003605054.CrossRefPubMed

52.

Katz PP, Yelin EH, Eisner MD, Earnest G, Blanc PD. Performance of valued life activities reflected asthma-specific quality of life more than general physical function. J Clin Epidemiol. 2004;57(3):259–67. http://dx.doi.org/10.1016/j.jclinepi.2003.08.007.CrossRefPubMed

53.

Nieuwkerk PT, Gisolf EH, Colebunders R, Wu AW, Danner SA, Sprangers MA, et al. Quality of life in asymptomatic- and symptomatic HIV infected patients in a trial of ritonavir/saquinavir therapy. AIDS. 2000;14(2):181–7.CrossRefPubMed

54.

Cohen C, Revicki DA, Nabulsi A, Sarocco PW, Jiang P, Group AHDRS. A randomized trial of the effect of ritonavir in maintaining quality of life in advanced HIV disease. AIDS. 1998;12(12):1495–502.CrossRefPubMed

Title: Relationship between CD4 count and quality of life over time among HIV patients in Uganda: a cohort study
Authors: Doris Mutabazi Mwesigire
Faith Martin
Janet Seeley
Achilles Katamba
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Health and Quality of Life Outcomes / Issue 1/2015
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/s12955-015-0332-3

At a glance: The STEP trials

Springer Medicine

Relationship between CD4 count and quality of life over time among HIV patients in Uganda: a cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Health related quality of life in adolescents with chronic fatigue syndrome: a cross-sectional study

Differences in utility scores obtained through Brazilian and UK value sets: a cross-sectional study

Evaluation of smoking-specific and generic quality of life measures in current and former smokers in Germany and the United States

Cross cultural translation, adaptation and reliability of the Malay version of the Canadian Acute Respiratory Illness and Flu Scale (CARIFS)

Spanish cultural adaptation and validation of the shoulder pain and disability index, and the oxford shoulder score after breast cancer surgery

Comparing the measurement equivalence of EQ-5D-5L across different modes of administration