Predictors for lower quality of life in the HAART era among HIV-infected men.

BACKGROUND: In the era of highly active antiretroviral therapy (HAART), maximizing health-related quality of life (QOL) has become a high priority of long-term management of HIV-infected individuals. Modifiable determinants of lower QOL should be identified for interventions specifically targeted to the HAART-using individuals to improve their QOL.

OBJECTIVE: To identify the predictors for lower QOL among HAART-using study participants in the Multicenter AIDS Cohort Study, a longitudinal study of HIV infection among homosexual and bisexual men in 4 cities.

METHODS: In the Multicenter AIDS Cohort Study, 636 HAART-using subjects had QOL data before HAART initiation and at least 2 consecutive QOL measurements after HAART initiation to visit 40 (April 2004). Variables of sociodemographics, individual risk behaviors, social support, biological markers, HIV-related medication use and clinical outcome indicators preceding the study outcomes, the physical health summary score and the mental health summary score derived from the standard SF-36 QOL form, were assessed as possible predictors using random-effects mixed models.

RESULTS: QOL before HAART initiation was a strong predictor of QOL subsequent to HAART initiation. Older age, lower socioeconomic status, less male sexual partners, no alcohol drinking, and more advanced HIV disease stage were significant predictors for lower physical health summary score. In addition, more outpatient visits, depression, amprenavir use, antiretroviral drug interruption, recreational drug use, and less social support were significantly associated with lower mental health summary score.

DISCUSSION: Many predictors of lower QOL are alterable risk factors that can be effectively targeted for interventions to maximize patients' QOL. With appropriate treatment and management of HIV disease and depression, clinicians can help improve the QOL of their patients. Through modification of individual risk behaviors, HIV-infected individuals can enhance their own QOL with support from clinicians and the community. In addition, active social support can also be an effective way to improve mental health of the infected persons.