Barcelona 2013
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| Abstract #575 - Psychological state | ||||
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Session: 6.7: Psychological state (Parallel) on Monday @ 11.00-13.00 in Auditorio Chaired by Barbara Hedge, Susannah Allison Authors: Presenting Author: Dr. Sean B. Rourke - The Ontario HIV Treatment Network, Canada |
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| Additional Authors: | ||||
| Aim: The objective of this study was to examine the contribution of neuropsychological (NP) status and medical comorbidities to health-related quality of life (HRQOL) among people living with HIV. | ||||
| Method / Issue: The sample included 317 people with HIV who were receiving care in an inner city hospital in Toronto, Canada. Mean age of the sample was 42.3 years, 78% were men, 57 % were gay, lesbian, or bisexual, 49% were Caucasian, 76% were on antiretroviral (ARV) treatment, and 63% had undetectable HIV viral load. Demographic data was collected through face-to-face interviews and clinical data were obtained from medical charts. The Veteran Aging Cohort Study (VACS) index was computed [median: 15; interquartile range: 6-26] based on age, gender, black race, HIV disease indicators, and indicators of liver and kidney systems injury. VACS index in the sample Participants? HRQOL was assessed with the SF-36 Health Survey which genereated two summary measures, Physical Component Score (PCS) and Mental Component Score (MCS), with higher scores indicating better HRQOL. A brief neuropsychological test battery was administered which included the Hopkins Verbal Learning Test ? Revised, Grooved Pegboard Test, WAIS-R Digit Symbol, and WMS-III Spatial Span. Test scores were converted to demographically corrected z-scores using published normative data. A composite NP indicator was created by averaging the individual test z-scores, with lower scores indicating greater impairment. Univariate and multivariate linear regression analyses were conducted to assess the independent contribution of the VACS index and NP status on HRQOL. | ||||
| Results / Comments: In univariate regression analyses, we found that the VACS index (B = -0.16; 95% CI: [-0.23, -0.09], p <0.001) and NP status (B=2.82; 95% CI: [1.34, 4.30], p <0.001) were associated with physical health-related quality of life (PCS), but not with mental health-related quality of life (MCS). In multivariate regression model, the VACS index (B= -0.08, 95% CI; [-0.16, -0.01], p=0.038) as well as NP status (B=1.58, 95% CI; [0.10, 3.05], p=0.036) remained significant predictors of PCS after adjusting for alcohol use, cigarette smoking, illicit drug use, time since HIV diagnosis, ARV treatment, CD4 nadir, and medical comorbidities including diabetes, cardiovascular diseases, and other comorbidities. This suggests that both medical comorbidities and NP status can affect HRQOL independently. Among the covariates examined, cigarette smoking (B= -2.94; 95% CI: [-5.33, -0.56], p=0.024) was significantly associated with PCS while diabetes showed marginal association with PCS (B= -4.57; 95% CI: [-9.18, 0.03], p=0.051). In a second multivariate regression model, the association between MCS and VACS index (B=0.01; 95% CI: -0.08, 0.10], p=0.762) and between MCS and NP status (B=1.32; 95% CI: -0.44, 3.09], p=0.140) remained not significant after adjusting for covariates. Among the covariates, lower alcohol use and longer duration since HIV infection were significantly (p<0.05) associated with higher MCS. | ||||
| Discussion: Our results indicate that neuropsychological status and medical comorbidities contribute independently to physical, but not to mental health-related quality of life. The clinical management of comorbidities and interventions to reduce medical comorbidities and cardiovascular disease risk factors (e.g., smoking) could lead to potentially significant benefits to improving health-related quality of life in HIV/AIDS. | ||||
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