European Journal of Cardiovascular Medicine

WHO defines Quality of life (QOL) as individuals’ perception of their position in life in the context of culture in which they live and interaction to their goal, expectation, standard and concerns. (1)

Numerous variables separated from physical and mental wellbeing like business status, age, sexual orientation, wage, education, HIV stage, seriousness of HIV disease, etc. are found to encroach on the QOL of PLHIV. Moreover, QOL is distinguished as a imperative medium to measure or decide the adequacy of treatment or investigations. So the present study examines the QOL of Indian PLHIV receiving ART and examines the variables that will influence it. (2)

As per worldwide HIV/AIDS gauges, total of 33 million people was living with HIV in 2007. The world's second most crowded nation, India, is encountering a exceedingly shifted HIV epidemic, which shows up to be stable or diminishing in a few parts whereas growing at a modest rate in others. (3)

Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHIV. (4)

Reported adult HIV prevalence in six states included in the recent national individual based survey (the National Family Health Survey 3, conducted in 2005 to2006) varied from 0.07% in UP (Uttar Pradesh), to 0.34% in TN(Tamil Nadu), 0.62% in Maharashtra, 0.69% in Karnataka, 0.97% in AP(Andhra Pradesh), & 1.13% in Manipur. (5)

The term QOL is connected in ordinary dialect and in a few diverse zones of information work. QOL has recently been logically characterized & it has been utilized as synonymous of wellbeing status, useful status, mental wellbeing, life joy, require fulfilment & appraisal of one’s own life. (6)

Studies on PLHIV/AIDS have utilized the term wellbeing related quality of life to survey the effect of wellbeing on social exercises and portability cantering whether there are signs and side effects and impacts of new drugs or wellbeing interventions. (7)

QOL was evaluated utilizing the WHO QOL-brief survey connected by prepared questioners. The WHO QOL-brief is easy to utilize instrument created by the WHO and approved in Brazilian Portuguese. (8)

AIM:

“To study the Quality of Life of people living with HIV (PLHIV) on minimum 10 years of Combination ARV therapy (c ART)”

This is a Descriptive and Cross-sectional study. Data was collected from patient file available in ART centre as mentioned in annexure 1 and Quality of Life was assessed by WHO questionnaire as mentioned in annexure 2.

Study Design:

Study Setting:

Out/inpatient patients of hospitals affiliated to Kasturba medical college, Mangalore i.e.

• “KMC hospital, Attavar”
• Wenlock Hospital, Mangalore

Inclusion criteria:

• HIV/AIDS Positive Regardless of language, age, sex, nationality, religion and race for a period of ten years
• On cART
• Infection Confirmed by ELISA OR WESTERN BLOTTING
• Age >18yrs
• Willing to give informed consent

Exclusion criteria:

• Age <18

Study was initiated after approval was obtained from the institutional ethics committee. Study related procedures and enrolment of eligible subjects was done only after obtaining an informed consent from the patient. Confidentiality of patient’s details was maintained at all levels using appropriate coding.

Subjects fulfilling inclusion & exclusion criteria were enrolled in to the study. 300 records were collected from ART centre KMC Attavar ID clinic ART centre who are on ART for A minimum of ten years.

Table 1 Shows age distribution in PL HIV

In age distribution 18 to 20 years are 2%, 21 to 30 are 15%, 31 to 40 50.3%, 41 to 50 are 24.3%, 51 to 60 are 6.7%, 61 to 70 are 1.3% and 71 to 80 are 1%. This indicates main age group affected is between 31 to 40 years indicating young age group is mainly affected.

Table 2 Shows frequency of HIV cases in association with sex of the individuals

70% were male patients and 30% were female indicating a greater number of HIV cases in male population.

Table 3 Shows statistics of quality of life

Median s 78.6 Range is between 64.2 to 90.70

Domain 1 is 16.93 indicating good QOL Domain 2 is 13.428 indicating good QOL Domain 3 is 13.20 indicating good QOL Domain 4 is 8.39 indicating poor QOL

Domain 5 is 14.349 indicating good QOL Domain 6 is 11.93 indicatind average QOL

Table 4 Shows statistics of quality of life in association with gender of the patient

Mean is 78.388 for males, and 77.924 for females p-value is 0.557 indicating no statistical difference with the gender and quality of life in HIV +ve patients

Table 5 shows association of smoking with quality of life in individuals with HIV on ART QOL VS Smoking

1. F=0.748, p=0.474 ns p-value is 0.474 indicates no statistical significance of smoking with quality of life.

Table 6 shows association of number of years on ART with quality of life

3. F=3.113 p=0.027 sig

P-value is 0.027 is significant statistically; indicates statistically significant association of number of years on ART with quality of life. This implies that increased number of years on ART is associated with better quality of life.

Table 7 Shows statistics of Domains 1,2 , 3, 4, 5 ,6

Median of Domains 1, 2, 3, 4, 5, 6 was 18. 13.6, 14, 8, 14, and 12 respectively Range of deviation of Domains 1, 2,3,4,5, 6 was between 11-20, 8-17, 9-16, 7-11, 13- 16.5 and 8-16 respectively

In our study, no significant association was found between education status and quality of life. Mostly because all our patients were educated up to primary or secondary school and all patients received similar treatment in the same hospital. All the patients belonged to a similar socio-economic status. However in a study done by Oluwafemi OOguntibeju in 2012 showed that Education, being an indicator of socioeconomic status, also influences QOL of people living with HIV and AIDS. Patients with higher education had better socio-economic status. Patients with higher education had better QOL, probably due to better knowledge regarding their treatment and disease, accessibility to health services, or functional status9. This suggests that ART works in combination with education and0socioeconomic status to bring about the desired0improvement in the QOL of people living with HIV and AIDS.

p-value is 0.557 indicating no statistical difference with the gender and quality of life in HIV +ve patients. In a study done by Tran BX et al in 2012 in Vietnam showed10 that men had higher scores or less morbidity and better psychological domains (p=0.02) and women had higher scores in performance.

In our study, P- values 0.31: is statically not significant implying mode of transmission does not influence quality of life. Sexual route accounted for infection in 63% cases while in 22% cases mode of transmission could not be elicited. Less common routes were injecting drug use (9%) and blood transfusion (6%). Heterosexual route was more common (70%). According to our study, P-value is 0.633 implying area of residence does not affect quality of life.

In a study by Jennifer A Pellowski in United states in 2013, patients living in rural areas were at risk for inadequate access to healthcare. cART has been proven to reduce viral loads, increasing CD4 counts and decreasing mortality.

However, Cohn and colleagues11 (2001) found out that few adults in rural areas of the United States received HIV care, and also rural patients were less likely to be taking ART regularly. Additionally, rural individuals started new and advanced HIV therapies later than their urban counterparts12.

Individuals living in rural areas are especially at risk for not having adequate access to health care. Antiretroviral therapy (ART) has-been proven effective in reducing viral loads, increasing CD4+ T cell counts, and decreasing mortality13,14

Lack of access to services and poor retention in medical care has been shown to predict poor health outcomes for PLWH, most notably in lower CD4+ T cell counts and more rapid disease progression15

In our study, P-value is 0.027 indicates statically significant association of number of years on ART with quality of life. This implies that increased number of years on ART is associated with better quality of life

According a study, if a patient is not started with ART, mortality occurs within 2 years. We have patients on ART for more than 10 years itself indicating that ART is associated with increased life expectancy.

1. Johnson LF, Mossong J, Dorrington RE, Schomaker M, Hoffmann CJ, Keiser O, et al. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013 Apr 9;10(4):e1001418.
2. Hamish MM, Catheri CO, Jennifer B, Mark B, Darren R, Karrie W, et al. Long-term survival in PLHIV up to 15 years of ART. PLoS One. 2012 Nov;7(11):e48839.
3. Antonio MM, Alberto CS, Carlos HL, Gloria HG, Carlos DH. Clinical and epidemiological differences between women and men with HIV infection in Mexico. J AIDS Clin Res. 2016;7(551):2.
4. Trickey A, May MT, Vehreschild JJ, Obel N, Gill MJ, Crane HM, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017 Aug 1;4(8):e349–56.
5. Brinkhof MW, Pujades-Rodriguez M, Egger M. Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis. PLoS One. 2009 Jun 4;4(6):e5790.
6. Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008 Jul 26;372(9635):293–9.
7. Poorolajal J, Hooshmand E, Mahjub H, Esmailnasab N, Jenabi E. Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis. Public Health. 2016 Oct 1;139:3–12.
8. Unnikrishnan B, Holla R, Darshan BB, Arjun BY, Thapar R, Mithra P, et al. Clinico-epidemiological profile of HIV-TB co-infected patients in Coastal South India. Manipal J Nurs Health Sci. 2015;1(1):9–13.
9. Mutabazi-Mwesigire D, Katamba A, Martin F, Seeley J, Wu AW. Factors that affect quality of life among people living with HIV attending an urban clinic in Uganda: a cohort study. PLoS One. 2015 Jun 3;10(6):e0126810.
10. Anand D, Puri S, Mathew M. Assessment of quality of life of HIV-positive people receiving ART: an Indian perspective. Indian J Community Med. 2012 Jul;37(3):165.
11. Dewan R, GK I, Jiloha RC. Assessment of quality of life among HIV-positive people attending tertiary hospital of Delhi, India. J Commun Dis. 2009;41(2):101–8.
12. Santos EC, França Junior I, Lopes F. Quality of life of people living with HIV/AIDS in São Paulo, Brazil. Rev Saude Publica. 2007 Dec;41:64–71.
13. Kumar A, Girish HO, Ayesha SN, Balu PS, Kumar BV. Determinants of quality of life among people living with HIV/AIDS: a cross-sectional study in Central Karnataka, India. Int J Med Sci Public Health. 2014;3(11).
14. Weiss RA, Dalgleish AG, Loveday C, Pillay D. Human Immunodeficiency Viruses. In: Zuckerman AJ, Banatvala JE, Pattison JR, Griffiths PD, Schoub BD, editors. Principles and Practice of Clinical Virology. 5th ed. Chichester: John Wiley & Sons Ltd; 2004. p. 721–57.
15. Korber B, Muldoon M, Theiler J, Gao F, Gupta R, Lapedes A, et al. Timing the ancestor of the HIV-1 pandemic strains. Science. 2000 Jun 9;288(5472):1789–96.
16. Pandey A, Sahu D, Bakkali T, Reddy DC, Venkatesh S, Kant S, et al. Estimate of HIV prevalence and number of people living with HIV in India 2008–2009. BMJ Open. 2012 Jan 1;2(5):e000926.