Health related quality of life among both current and former injection drug users who are HIV-infected

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Abstract

Background

This study aimed to determine factors associated with higher levels of health related quality of life (HRQL) among individuals HIV-infected through drug injection and to evaluate the impact of injecting drug status and opiate substitution treatment (OST) on HRQL.

Methods

Two hundred and forty-three patients, enrolled in the MANIF cohort of patients HIV-infected through IDUs, participated. They completed a self-administered questionnaire, which included an HRQL evaluation (SF-12) and socio-demographic/clinical characteristics at the 42-month visit. Injecting drug status, OST and experience of negative life events (NLE) were collected at any follow-up visit in order to reconstitute individual trajectories.

Results

Among the 243 patients, 35% reported a normal mental HRQL and 37% a normal physical HRQL. Independent predictors of “normal” mental HRQL were social support from partner, being a former IDU, no experience of violence-related NLE and few self-reported HAART-related side effects. “Normal” physical HRQL was predicted by younger age, stable partner, being a former IDU (≥6 months), CD4 cell count >500, no experience of financial-related NLE and few HAART self-reported side effects.

Conclusions

As HRQL has been found to have a prognostic value on the survival of HIV patients infected through drug injection, then providing more comprehensive care (for example by paying more attention to patients’ experience of stressful events, meeting their needs in psychosocial support and better management of perceived toxicity) could globally improve treatment outcomes in this vulnerable population.

Introduction

The considerable improvement in the prognosis of HIV-infected patients induced by highly active antiretroviral therapy (HAART) (Allardice et al., 1998, Cascade and Collaboration, 2000, Sabin, 2002), has dramatically prolonged patients’ survival and also highlights new psychosocial questions pertaining to “how” patients live, both with their disease and their life-long treatment. Along with a striking reduction in opportunistic infections, patients on HAART also experience an improvement in their quality of life (Carrieri et al., 2003). Patient “well-being” in those living with HIV in the HAART era is not only determined by the patient's response to treatment but also by other social and psychological dimensions (Carrieri et al., 2003, Preau et al., 2004, Preau et al., 2005, te Vaarwerk and Gaal, 2001). However, studies focusing on quality of life in specific minorities such as drug users remain limited and are generally based on a “drug maintenance treatment programs” recruitment basis (Litwin et al., 2005). Some studies have shown that a history of injecting drug use (and what is experienced with it) is detrimental to HRQL and that active injecting drug users (IDUs) have lower levels of HRQL (Dalgard et al., 2004).

Individuals who have been HIV-infected through injecting drug use may be even more socially vulnerable than HIV negative IDUs due to the dual nature of their need of support (support for HIV and for drug use). For these individuals, more support could be given by increasing the access to sources (associations, peers, counselling, etc…) and the ways to address it (Knowlton et al., 2004, Knowlton et al., 2005). In this specific population, the burden of co-morbidities (HCV, HBV, tuberculosis) (Moore et al., 2004) as well as delayed access to antiretroviral treatment may have an additional negative impact on HRQL (Carrieri et al., 1999, McNaghten et al., 2003, Moore et al., 2004).

Since 1995, the French health insurance system has authorised the prescription of methadone (mainly in specialist centres) and buprenorphine (mainly office-based) to IDUs seeking medical care for their opiate dependence. Simultaneous to this important evolution was the access to HAART, which became available in 1996.

However, the relative impacts of HIV disease, history of drug use and opiate substitution treatment (OST) on mental and physical HRQL are unknown in individuals HIV-infected through injecting drug use, once their life events experience is also taken into account.

Longitudinal data from the MANIF 2000 cohort of individuals HIV-infected through injecting drug use provides the ideal framework to better understand the different components of HRQL of HIV-infected IDUs in the HAART era, due to the fact that the follow-up of these patients allows drug injection trajectories to be taken into account.

Section snippets

Setting

MANIF 2000 is a French cohort that enrolled 467 patients HIV-infected through injecting drug use between 1995 and 1997. This cohort aimed at investigating socio-behavioural aspects of their HIV and drug use experience (Carrieri et al., 1999, Moatti et al., 2000). Follow-up visits were scheduled every 6 months. At each visit, patients were asked to participate in a face-to-face interview about their experience with HIV infection, drug use and other stressful events. They were also asked to

Results

At month 42, 311 patients had a clinical and a socio-behavioral assessment. Of these, 243 participants with complete HRQL data (SF12) were compared with 68 patients excluded from the analyses as these latter had at least one item missing in the SF-12 questionnaire. The participants did not significantly differ from the excluded patients concerning age, employment, CD4 cell count, AIDS related clinical stage, undetectable viral load, HAART treatment and drug injection status. Participants who

Discussion

The aim of this study was to evaluate the effects of experiences related to HIV infection, drug use, substitution treatment and social conditions on mental and physical HRQL in individuals who were HIV-infected through drug injection. The study shows that there is a common set of factors such as self-reported side effects, which are detrimental to HRQL, while others intervene only in one specific dimension of HRQL. More precisely, injecting drug status, recent experience of drug injection

Acknowledgements

This research was supported by The French National Agency for Aids Research (ANRS, France), the charity organisation ECS-SIDACTION (France), and the Departmental Council (Bouches-du-Rhône, France). We thank all members of the MANIF 2000 cohort study group: C. Boirot, A.D. Bouhnik, M.P. Carrieri, J.P. Cassuto, M Chesney, P. Dellamonica, P. Dujardin, H. Gallais, J.A. Gastaut, G. Lepeu, C Marimoutou, D. Mechali, J.P. Moatti, J. Moreau, M. Nègre, Y. Obadia, I. Poizot-Martin, C. Pradier, M. Préau,

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