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Differences in heath-related quality of life (HRQL) measured by the PROQOL-HIV, a new specific instrument developed across cultures

Duracinsky, M., Acquadro, C., Lalanne, C., Herrmann, S., Lau, J., Lecoeur, S., Schechter, M., Berzins, B., Fournier-Nicolle, I., Diouf, A. and Chassany, O. (2009) Differences in heath-related quality of life (HRQL) measured by the PROQOL-HIV, a new specific instrument developed across cultures. In: 5th IAS conference on HIV Pathogenesis Treatment and Prevention, 19 - 22 July, Cape Town, South Africa.


Background: The PROQOL-HIV questionnaire, a new instrument measuring the health-related quality-of-life (HRQL) of PLWHA in different cultures, was developed to face the challenges of the HAART era. This study presents the biopsychosocial and clinical factors impacting on HRQL in 8 populations identified by PROQOL-HIV.

Methods: 830 individuals from Australia, Brazil, Cambodia, China, France, Senegal, Thailand and the USA completed the cross-sectional PROQOL-HIV survey. Statistical analyses of HRQL scores were obtained using PROQOL-HIV and correlated with socio-demographic and clinical data, including self reported symptoms.

Results: Mean age was 41±10 years, (37% women, 86% treated). CD4 mean number was 428±268 cells/µL, 75% had undetectable viral load. Total HRQL scores (N=822) were expressed on a 100-point scale, and were similar across most populations. However HIV infection had a greater impact on the HRQL of Chinese and Khmer [with lower HRQL scores (p< .001)], particularly on physical health and symptoms, health concerns, and stigma dimensions (adjusted for multiple comparisons p< .001).Most frequently reported symptoms were tiredness (53%), insomnia (44%), and headache (44%). HRQL scores were inversely correlated with the frequency of self-reported symptoms (p< .001) and varied according to gender (p=0.01): women had mean HRQL scores (60.5±17.5 points) lower than men (63.7±18.1). Individuals with hepatitis co-infection, a psychiatric disorder or an HIV-related disease had lower HRQL scores across all populations (all p< .001) The CD4 count and having an undetectable viral load were also associated with improved HRQL (p< .001): 57.3±18.1(< 250 CD4) vs. 63.5±17.5(>500 CD4) and p< .001, 95%CI [2.7-8.4] respectively, and differed according to the CDC stage (p< .001): 60.2±18.4 (stage C) vs. 63.7±17.7 (non-C stage). Self-reported adherence was high and not associated with HRQL, confirming that HRQL is an important endpoint to measure.

Conclusions: PROQOL-HIV is a valid questionnaire to assess the quality-of-life of PLWHA and is sensitive to clinical outcome measures and cultural differences.

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