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Rates and Drivers of Quality of
Life With HIV Differ in Netherlands and UK
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European Workshop on Healthy Living With HIV 2019, Barcelona, September 13-14, 2019
Mark Mascolini
Quality of life (QoL) in a Netherlands HIV group matched that of the country' general population and proved significantly higher than QoL of people with HIV in the United Kingdom (UK) [1]. More anxiety/depression and pain/discomfort in the UK largely accounted for the difference from the Netherlands.
Dutch and UK collaborators noted that increasing longevity among people with HIV magnifies the importance of ensuring high QoL in aging HIV groups. To compare QoL with HIV versus the general population in two countries, and to identify factors linked to QoL with HIV in each country, they conducted this analysis of more than 5000 HIV-positive people in the Netherlands and the UK.
The Netherlands sample consisted of people attending an HIV outpatient clinic at a tertiary-care hospital, a group representative of the entire Netherlands HIV population. The UK sample came from 73 HIV outpatient clinics across the country, also a nationally representative sample. From June 2016 until December 2018, researchers asked all Netherlands participants to complete the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaire, which records subjectively determined severity levels in 5 domains and is validated in people with HIV. From January to September 2017, a random sample of HIV clinic attendees in the UK completed the Positive Voices survey, including the EQ-5D-5L.
The analysis focused on 916 HIV-positive people in the Netherlands (17%) and 4422 in the UK (83%). Most participants in the Netherlands (77%) and the UK (73%) were men, a result reflecting sex between men as the main HIV transmission route (60% and 55%). Almost half of participants in both countries were migrants, with a higher proportion in the UK from sub-Saharan Africa (28% versus 15%). Age averaged 49.5 in the Netherlands and 48.1 in the UK.
An EQ-5D-5L score of 1.0 represents perfect health, while a score of 0 means death. QoL among Netherlands participants with HIV (0.86) proved virtually identical to QoL of the general Netherlands population (0.87). Compared with the Dutch HIV group, UK participants with HIV had a significantly lower QoL (0.83, beta -0.03, 95% confidence interval [CI] -0.04 to -0.02), and this UK HIV QoL did not match the UK general-population QoL (0.88) (P < 0.001). Among people with HIV, lower QoL in the UK group reflected higher rates of anxiety/depression than in the Netherlands (50% versus 34%) and more frequent pain/discomfort (46% versus 36%). UK participants also scored lower than Netherlands participants in the three other EQ-5D-5L domains: mobility, self-care, and usual activities (P < 0.05 for all 5 differences).
Predictors of low QoL differed between the Netherlands and the UK. Significant predictors in the Netherlands were age over 60 years (beta -0.05, 95% CI -0.08 to -0.01) and female gender (beta -0.03, 95% CI -0.06 to -0.01). Predictors of low QoL in the UK were birth in the UK (beta -0.05, 95% CI -0.03 to -0.08) and drug injection as an HIV risk factor (beta -0.01). Multivariable analysis that included sociodemographic factors identified three overall predictors of low QoL: smoking (beta -0.04, 95% CI -0.06 to -0.02), lower education level (beta -0.04, 95% CI -0.08 to -0.01), and lower income (beta -0.17, 95% CI -0.22 to -0.12).
The Netherlands-UK team proposed that "social and behavioral interventions, particularly addressing mental health, may lead to further improvements in QoL among people with HIV." They argued that determining health-related QoL should become a regular part of HIV care.
Reference
1. Popping S, Kall M, Stempher E, et al. Country specific factors determine the quality of life among people with HIV in two western European countries. European Workshop on Healthy Living With HIV 2019. Barcelona. September 13-14, 2019. Abstract 4.
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