Impact of Antiretroviral Therapy on Quality of Life in HIV-Infected Southeast Asian Children in the PREDICT Study

Abstract

Quality of life (QOL) is an important antiretroviral treatment (ART) outcome. We compared QOL among 299 Thai and Cambodian children ages 1-12 years-old, CD4 15-24% randomized to early (ART at week 0, N = 149) versus deferred groups (ART when at CD4 < 15%, N = 150) and also compared with QOL data from age-matched healthy controls (N = 275). Primary caregivers completed PACTG QOL questionnaires at week 0 and every 24 weeks until 144 weeks. Children were enrolled during March 2006 to September 2008. Mean (SD) age of children was 6.3 (2.8) years, 58% were female, 60% were Thai, %CDC N:A:B:C was 2:62:36:0%. During 144 weeks, all children in the early-group and 69 (46%) of deferred-group children started ART. There was no significant difference of QOL scores between treatment groups at baseline (all p > 0.05) and at week 144 (all p > 0.05). By multivariate analysis, the early-group had higher QOL score changes in five domains, including health perception ( p = 0.04), physical resilience ( p = 0.02), psychosocial well-being ( p = 0.04), social and role functioning ( p < 0.01), and symptoms ( p = 0.01) compared to the deferred group. QOL of HIV-infected children in both groups were lower than healthy control in all 7 domains at baseline (all p < 0.05) and 5 of 7 domains at weeks 144 ( p < 0.01). In conclusion, no significant difference of QOL scores between treatment groups. Early ART commencement associated with greater increase of QOL scores over 144 weeks. QOL scores in HIV-infected children were lower than healthy controls.

CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care

“…Research conducted among children and adolescents in Uganda [41], Kenya [42], the Democratic Republic of Congo [43], Rwanda [44], Thailand and Cambodia [45] has consistently showed the detrimental effects of HIV infection on cognition, intelligence, behavior, memory and psychomotor outcomes. These neurocognitive deficits can result in negative school performance and other social interactions.…”

Quality of life assessment among HIV‐positive persons entering the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

“…Health-related QOL is a multidimensional concept that reflects one's subjective self-assessment of physical, emotional and functional status [1,2], reflecting the World Health Organization's definition of health as 'a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity' [3]. In the HAART era, a number of studies, including HIV clinical trials, have assessed QOL in PLWH [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. For example, in the Strategies for Management of Antiretroviral Therapy (SMART) trial comparing continuous versus episodic therapy, continuous therapy resulted in improved outcomes for a number of QOL measures, including those related to self-perceived physical health [8].…”

The Linkage of Illicit Drug Use / Alcohol Use and HIV Infection in Young Adults

“…Infants born with HIV infection have an excellent survival rate when provided antiretroviral treatment under WHO treatment guidelines (19). However, infants born with HIV infection have more factors associated with failure to thrive, and as they progress through childhood, adolescence and young adulthood experience poorer health and lower quality of life (20,21). These individuals, living with HIV, as they progress to young adulthood, have a higher risk of prescription drug abuse, as well as, illicit drug and alcohol use due to both increase chronic health issues, as well as, the stigma and discrimination of growing up with HIV infection (22).…”