The expansion of ART for HIV infection has helped reduce disparities in health-related quality of life between HIV-positive and HIV-negative individuals in Zambia and South Africa, according to findings published in The Lancet Global Health.
“Little evidence exists about the [health-related quality of life (HRQoL)] of HIV-positive people at various stages of engagement in HIV care, when benchmarked against the attainable HRQoL of the HIV-negative population,” Ranjeeta Thomas, PhD, research associate in the Centre for Health Policy at Imperial College London School of Public Health, and colleagues wrote. “Evidence about the effectiveness of ART in reducing the extreme inequalities in population health caused by HIV in high-burden settings is a crucial piece of evidence missing from the current debate. Such evidence would garner support for reducing the funding gap required to achieve the UNAIDS 2020 Fast-Track 90-90-90 targets.”
To compare the HRQoL of HIV-positive people with that of HIV-negative people in Zambia and South Africa— two countries where the prevalence of HIV infection exceeds 20% — researchers analyzed data from a sample of the population that was included in the HPTN 071 study, an ongoing randomized trial measuring the effect of a prevention intervention on HIV incidence. Their analysis included 19,750 adults aged 18 to 44 years in Zambia and 18,941 adults in South Africa between Nov. 28, 2013 and March 31, 2015. They assessed differences in HRQoL scores between HIV-negative and HIV-positive individuals who were:
- unaware of their infection status;
- aware but not in HIV care;
- in HIV care but who had not initiated ART;
- on ART for less than 5 years; and
- on ART for 5 years or more.
In total, HIV status was available for 19,330 participants in Zambia and 18,004 participants in South Africa; 4,128 (21%) of those in Zambia and 4,012 (22%) of those in South Africa were HIV positive. According to the researchers, HRQoL scores were not significantly different in individuals who had started ART more than 5 years ago and HIV-negative individuals, neither in Zambia (change in mean score, 0.002; 95% CI, 0.01 to 0.001; P = .219) nor in South Africa (change in mean score, 0.000; 95% CI, 0.002 to 0.003; P = .939). In contrast, scores differed between HIV-positive participants who had been on ART less than 5 years and HIV-negative individuals in Zambia (change in mean score, 0.006; 95% CI, 0.008 to 0.003; P < .0001).
Notably, 1,768 of 4,128 (43%) of HIV-positive people in Zambia and 2,026 of 4,012 (50%) HIV-positive people in South Africa were unaware of their HIV status and reported good HRQoL, with no significant differences from that of HIV-negative people. HRQoL scores were slightly lower among HIV-positive people who were aware of their status but not enrolled in HIV care (change in mean score, 0.004; 95% CI, 0.01 to 0.001; P = .01) and those in HIV care but not on ART (change in mean score, 0.008; 95% CI, 0.01 to 0.004; P = .001) than among HIV-negative people in South Africa.
“The unique design of our study allowed us to identify the success of ART in reducing inequalities between the HRQoL of HIV-infected individuals and the HIV-negative population. But our findings are also a call to step up efforts to extend these benefits to the millions of people not yet on ART,” Thomas and colleagues wrote. “Improved access to ART is considered the main reason for the marked increase in overall life expectancy in sub-Saharan Africa over the last decade. Policy makers should remember the purpose of medical treatment is to add years to life, and life to years.”
In an accompanying editorial, Kristen A. Donald, MBChB, PhD, from the division of developmental pediatrics and the department of pediatrics and child care at the University of Cape Town, South Africa, wrote that the findings of Thomas and colleagues will help in the management of HIV in a population where the disease remains prevalent.
“The authors provide a strong argument for getting individuals diagnosed with HIV onto treatment rapidly, not only in order to preserve and optimize their physical health, but also to give people hope for their future,” Donald wrote. – by Savannah Demko
Disclosures: Thomas and other authors report grants from the NIH, the President’s Emergency Plan for AIDS Relief and the International Initiative for Impact Evaluation. Please see the study for all other authors’ relevant financial disclosures. Donald reports no relevant financial disclosures.