Quality of life among people living with HIV in England and the Netherlands: a population-based study

Abstract

Background HIV is now considered a chronic condition, and people living with HIV, when treated, have a similar life expectancy as compared to the general population. Consequently, improving and ensuring a good health-related quality of life (HrQoL) among people living with HIV (people living with HIV) is increasingly important and has risen on the global agenda in recent years. A ‘fourth 90’ as 90% of people with viral load suppression have a good HrQoL should therefore be adopted alongside the other 90-90-90 targets. This study aims to report the progress on HrQoL as the ‘fourth 90’ and compare against the general population in the Netherlands and England. Methods In the Netherlands, individuals attending the HIV outpatient clinic of a tertiary hospital were asked to complete the EQ-5D-5L from June 2016 until December 2018. In England, individuals attending one of 73 HIV outpatient clinics were randomly sampled to complete the Positive Voices survey, which included the EQ-5D-5L, from January to September 2017. HrQoL scores were combined with demographic data and compared to general population data. Findings The EQ-5D-5L was filled-out by 895 people living with HIV in the NL and 4,137 in England. HrQoL utility was 0·85 among Dutch and 0·83 among English people living with HIV. This equated to 98% and 94% of the general population HrQoL utility in the Netherlands and England, respectively. Of the EQ-5D domains, anxiety/depression was mostly affected, with one-third in Dutch (35%) and almost half (47%) of English people living with HIV reporting symptoms. This was higher compared to their respective general populations (21% NL and 31% England). Interpretation Overall, HrQoL utility for people living with HIV was high in both countries and highly comparable to the general populations Nevertheless, there should be an increased focus on anxiety and depression in the people living with HIV population The EQ-5D-5L proved an easy HrQoL measurement tool and identified areas for improvement by social and behavioural interventions. Funding The study received funding (unrestricted grants) from: Gilead sciences, ViiV Healthcare, MSD, and Jansen pharmaceuticals.

Significant liver fibrosis is a predictor of poor health-related quality of life in people living with HIV

“…The EF and GHP domains showed the lowest scores overall, which is in line with these recent studies [41,42]. Overall, cultural and country-specific differences need to be considered in the assessment of HRQL [37].…”

“…Overall, PLWH and significant fibrosis may characterize a population at risk that needs closer monitoring and counseling to improve the negative impact on HRQL. Previous studies have often highlighted a higher prevalence of mental health problems, including anxiety and depression, in PLWH [37,38]. In our study, the mental health domain had an overall lower score compared to other domains, although no difference was seen in the fibrosis subgroup.…”

Effect of hepatic steatosis and associated metabolic comorbidities on health‐related quality of life in people living with HIV

“…[ 44 ] Popping et al recently found a high prevalence of anxiety/depression in PLWH compared with the general population, especially if patients were >60 years of age. [ 25 ] Notably, older age remained independently associated with low HRQL in the subgroup analysis without HS in this study. Although the anxiety/depression dimension was prominent in both subgroups, they were not significantly different from each other.…”

“…Overall, the differences in these HRQL findings may be multifactorial and country‐specific. [ 25 ] According to previous studies, low socioeconomic status and income are often associated with low HRQL. [ 40 ] We were not able to see an effect of unemployment or education level on the HRQL in PLWH and without HS.…”

“…Moreover, no data exist from the generic EQ‐5D‐5L questionnaire related to HRQL in PLWH from Germany, although country‐specific differences may exist. [ 21 , 25 ] Therefore, the aim of this prospective study was to determine differences in HRQL between PLWH with and without HS, and to identify treatable predictors of an impaired HRQL in both groups.…”