Psychometric assessment of health-related quality of life and symptom experience in HIV patients treated with antiretroviral therapy

Purpose Symptoms which are found to cluster consistently can have synergistic effects on patient outcomes and therefore may serve to predict morbidity or disentangle disease progression from comorbid conditions. Self-report HIV-specific symptom and HRQL measures were jointly analyzed in HIV-positive patients under different antiretroviral treatment regimens. Methods The responses of N=365 patients from four countries to the 9-item Physical Health and Symptom dimension of the PROOQL-HIV questionnaire and an HIV Symptom checklist were analyzed. Item response modeling and multidimensional scaling were used to derive HRQL scores free of any differential item functioning related to gender and target language and to summarize symptom co-expression in patients under protease inhibitor treatment (PI, N=164 , 45 %) versus other medication (Non-PI). Results Women reported poorer HRQL ( p=0.037 ), and HRQL did not differ between the target languages of French, English, and Thai. Fatigue, muscular pain, or difficulties falling asleep was the most frequently reported symptoms >35 %). PI versus Non-PI patients exhibited different pattern of symptoms with lipodystrophy-related and gastrointestinal symptoms forming well-separated clusters in the PI group. A higher number of symptoms were associated with lower HRQL ( p<0.001 ), and patients taking PIs reported lower HRQL ( p=0.003 ). Patients in both groups who reported fatigue, sexual dysfunction, or several lipodystrophy-related symptoms had poorer quality of life. Conclusion The co-expression of symptoms and their relation to HRQL are important aspects for the monitoring of HIV treatments.