Health-Related Quality of Life and Associated Characteristics among Men Who Have Sex with Men and Transgender Women with HIV in Lima, Peru

Abstract

Background: Clinical care for people living with HIV (PLWH) increasingly incorporates quality of life considerations due to advances in HIV treatment and decline in HIV-related mortality. Men who have sex with men (MSM) and transgender women (TW) constitute the majority of new HIV infections in Lima, Peru, and there is currently limited research evaluating health-related quality of life (HRQOL) determinants in these populations. Methods: We analyzed differences in health-related quality of life between HIV-positive participants from the Sables study who were randomized to either initiate antiretroviral therapy (ART) immediately or to defer ART for 24 weeks after HIV diagnosis. Items from the Short Form (SF)-12 survey were evaluated as individual HRQOL outcomes, and bivariate and multivariate logistic analyses were used to assess the relationship between HRQOL, demographic characteristics and baseline CD4 count. Results: The results of bivariate analyses indicated that participants who initiated ART immediately were more likely to report better general health at 48 weeks post HIV diagnosis (prevalence ratio (PR): 1.11, 95% confidence interval (CI) [1.01, 1.21]). Multivariate analyses revealed participants who reported higher HIV-related aversive coping at 48 weeks were more likely to report more limitations with moderate physical activities (adjusted prevalence ratio (APR): 0.86, 95% CI [0.77, 0.97]) and with climbing several flights of stairs (APR: 0.89, 95% CI [0.80, 0.99]), increased limitations with social functioning (APR: 0.70, 95% CI [0.58, 0.85]), elevated psychological distress (APR: 0.73, 95% CI [0.58. 0.92]), and more role limitations due to physical health (APR: 0.89, 95% CI [0.80, 0.99]). Baseline CD4 count of 500 cells/uL or higher was found to be associated with less psychological distress (APR: 1.36, 95% CI [1.01, 1.83]) and less interference on normal work due to pain (APR: 1.37, 95% CI [1.01, 1.88]). Conclusions: Among HIV-positive MSM and TW participants in Lima, Peru, self-perceived general health status at 48 weeks was greater in the immediate ART arm compared to those who deferred ART for 6 months after HIV diagnosis. One year after HIV diagnosis, higher HIV-related aversive coping was associated with worse HRQOL outcomes. Higher CD4 count at diagnosis was associated with less psychological distress 1 year after HIV diagnosis.