Protease Inhibitor Combination Therapy, Severity of Illness, and Quality of Life Among Children With Perinatally Acquired HIV-1 Infection

Abstract

ABSTRACT.Objectives. This study examines quality of life (QOL) among school-aged children with perinatally acquired HIV infection and compares QOL outcomes between treatment groups that differ according to the use of protease inhibitor (PI) combination therapy (PI therapy). To gain insights into how PI therapy might influence QOL, associations between severity of illness and QOL were also investigated.Methods. Cross-sectional data for 940 children, 5 to 18 years of age, who were enrolled in Pediatric AIDS Clinical Trials Group Late Outcomes Protocol 219 were used to examine domains of caregiver-reported QOL, as assessed with the General Health Assessment for Children, during 1999. The General Health Assessment for Children is an age-specific, modular, QOL assessment that was developed for the study with previously validated measures. QOL differences between treatment groups were estimated with linear and logistic regressions that controlled for sociodemographic characteristics (age, gender, race/ethnicity, maternal/caregiver education, and respondent) and severity-of-illness indicators related to receipt of PI therapy (AIDS status, log 10 CD4 ؉ cell counts, and height-for-age z scores).Results. The mean age of participants was 9.7 years. Most children were non-Hispanic black (54%) or Hispanic (31%), and 49% of the participants were female. At the 1999 study visit, ϳ14% of children had severe immune suppression (<15% CD4 ؉ cells), whereas 62% of children had >25% CD4 ؉ cells, ie, no immune suppression. Participants did exhibit some lag in growth, with mean height and weight z scores of ؊0.70 and ؊0.20, respectively. Twenty-eight percent of the children were reported to have met criteria for AIDS at study entry (1993)(1994)(1995)(1996)(1997)(1998)(1999). When treatment groups were compared, children receiving PI therapy (72%) were older, had lower CD4 ؉ cell percentages, and had lower height and weight z scores than did those receiving non-PI therapies. They were also more likely to have met criteria for AIDS at study entry. The most commonly used PIs were ritonavir (46%) and nelfinavir (63%). Health perceptions ratings for most children were at the upper end of the scale, whereas ratings for 25% of the children ranged over the lower 70% of scale scores. Almost one half of the children had at least some limitations in physical functioning, with more frequent limitations in energydemanding activities (46%) than in basic activities of daily living (32%). The Behavior Problems Index was used to assess psychologic functioning. The mean total Behavior Problems Index score (9.34) and the proportion of children with extreme scores (23%) were consistent with values reported for chronically ill children and those at social and economic risk. One or more limitations in social/school functioning were reported for 58% of children. More than one third of the children (38%) experienced >1 physical symptoms that were at least moderately distressing. Health perceptions, physical functioning, psychologic functioning, social/school...

HRQoL in HIV-infected children using PedsQL™ 4.0 and comparison with uninfected children

“…We think that the findings of those receiving any antiretroviral treatment had better emotional functioning and fewer symptoms than did those receiving no antiretroviral treatment are reassuring. Antiretroviral treatment may indeed be associated with improved QoL among HIV-infected children, similar to the experience in earlier studies [17,22].…”

“…Mixed model was used to determine the correlation between the infected children and their siblings acting as controls. Multivariate, linear regression models were constructed to assess the association of infection status with QoL domains with adjustment for demographic and social/ environmental characteristics, including age, gender, primary caregiver, age of primary caregiver, and gender of primary caregiver [17][18][19]. We also constructed adjusted, multivariate regression models to assess the association of treatment regimens with QoL domains and to determine the association of the quality of care received with QoL domains.…”

Progress and challenges in antiretroviral therapy for HIV-infected children

“…This issue was addressed in a cross-sectional study of 940 perinatally infected children 5 to 18 years of age [9], in which PI therapy improved the quality of life or at least attenuated its decline in children with more advanced HIV infection. Notably, one third of the cohort still experienced physical symptoms that were at least moderately distressing.…”

Health Related Quality of Life Assessment questionnaire for children aged 5 to 11 years with HIV/AIDS: cross-cultural adaptation for the Portuguese language

“…The questionnaire is based on a multidimensional conceptualization of health perceptions, physical resilience, physical functioning, psychological, social/role functioning, health care utilization and HIV-symptoms. This questionnaire was used in studies with HIV/AIDS infected children and has presented evidence of validity in this population 4,5,6 .…”