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Number of HIV symptoms more accurately predicts patients' quality of life than disease stage or CD4 cell count

Health-related quality of life for people infected with HIV depends most on the degree of symptoms they suffer. In fact, those who have symptomatic HIV disease have worse physical and mental health than people with most other chronic diseases. After controlling for symptoms, race, sex, health insurance status, disease stage, and CD4 cell count (an indicator of HIV disease progression) are at most only weakly associated with the physical and mental health of patients with HIV disease, concludes a study that was supported in part by the Agency for Healthcare Research and Quality (HS08578).

Researchers from the University of California, Los Angeles, RAND, Harvard Medical School, and other institutions studied 2,864 HIV-infected adults who participated in the HIV Cost and Services Utilization Study (HCSUS). HCSUS data represent a probability sample of all adults receiving care for HIV disease in the United States.

The researchers compared patients' physical functioning and emotional well-being, based on summary scores of a battery of physical and mental health tests, with those of the U.S. general population and patients with other chronic diseases. They also examined the associations of demographic characteristics, stage of illness, CD4 count, symptoms, and other factors with physical functioning and emotional well-being.

Compared with the general U.S. population, adults with asymptomatic HIV disease had similar physical functioning, but those with symptomatic HIV disease or AIDS had much worse physical functioning. Patients with AIDS had worse physical functioning than those with other chronic diseases, such as epilepsy, localized prostate cancer, clinical depression, and diabetes. People at all stages of HIV disease had significantly worse emotional well-being than either the general population or patients with other chronic diseases, except depression.

After adjusting for the number of symptoms, having AIDS was no longer associated with the mental health score and was only weakly associated with the physical health score. The association of lowest CD4 count with health-related quality of life also was only modest after adjusting for the number of symptoms. The authors conclude that more effective clinical management of HIV-related symptoms may improve functioning and well-being in these patients.

See "Health-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV Cost and Services Utilization Study," by Ron D. Hays, Ph.D., William E. Cunningham, M.D., M.P.H., Cathy D. Sherbourne, Ph.D., and others, in the June 15, 2000 American Journal of Medicine 108, pp. 714-722.

Reprints (AHRQ Publication No. 01-R010) are available from the AHRQ Publications Clearinghouse.

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