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Effect of Treatment Interruption and Intensification of Antiretroviral Therapy on Health-Related Quality of Life in Patients with Advanced HIV

Author

Listed:
  • Vilija R. Joyce
  • Paul G. Barnett
  • Adam Chow
  • Ahmed M. Bayoumi
  • Susan C. Griffin
  • Huiying Sun
  • Mark Holodniy
  • Sheldon T. Brown
  • Tassos C. Kyriakides
  • D. William Cameron
  • Mike Youle
  • Mark Sculpher
  • Aslam H. Anis
  • Douglas K. Owens

Abstract

Background . The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown. Objective . To assess the impact of temporary treatment interruption and intensification of ART on HRQoL. Design . A 2 x 2 factorial open label randomized controlled trial. Setting . Hospitals in the United States, Canada, and the United Kingdom. Patients . Multidrug resistant (MDR) HIV patients. Intervention . Patients were randomized to receive a 12-wk interruption or not, and ART intensification or standard ART. Measurements . The Health Utilities Index (HUI3), EQ-5D, standard gamble (SG), time tradeoff (TTO), visual analog scale (VAS), and the Medical Outcomes Study HIV Health Survey (MOS-HIV). Results . There were no significant differences in HRQoL among the four groups during follow-up; however, there was a temporary significant decline in HRQoL on some measures within the interruption group during interruption (HUI3 −0.05, P = 0.03; VAS −5.9, P = 0.002; physical health summary −2.9, P = 0.001; mental health summary −1.9, P = 0.02). Scores declined slightly overall during follow-up. Multivariate analysis showed significantly lower HRQoL associated with some clinical events. Limitations . The results may not apply to HIV patients who have not experienced multiple treatment failures or who have not developed MDR HIV. Conclusions . Temporary ART interruption and ART intensification provided neither superior nor inferior HRQoL compared with no interruption and standard ART. Among surviving patients, HRQoL scores declined only slightly over years of follow-up in this advanced HIV cohort; however, approximately one-third of patients died during the trial follow up. Lower HRQoL was associated with adverse clinical events.

Suggested Citation

  • Vilija R. Joyce & Paul G. Barnett & Adam Chow & Ahmed M. Bayoumi & Susan C. Griffin & Huiying Sun & Mark Holodniy & Sheldon T. Brown & Tassos C. Kyriakides & D. William Cameron & Mike Youle & Mark Scu, 2012. "Effect of Treatment Interruption and Intensification of Antiretroviral Therapy on Health-Related Quality of Life in Patients with Advanced HIV," Medical Decision Making, , vol. 32(1), pages 70-82, January.
    • Handle: RePEc:sae:medema:v:32:y:2012:i:1:p:70-82
    DOI: 10.1177/0272989X10397615
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    References listed on IDEAS

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    1. Feeny, David & Furlong, William & Saigal, Saroj & Sun, Jian, 2004. "Comparing directly measured standard gamble scores to HUI2 and HUI3 utility scores: group- and individual-level comparisons," Social Science & Medicine, Elsevier, vol. 58(4), pages 799-809, February.
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