916 Assessing Health-related Quality of Life in Routine Clinical Care of HIV-infected Patients H. Crane*, A. Young, M. Kitahata Univ of Washington, Seattle
Background: Health-related quality of life (HRQL) measures assess health status from the patient’s (pts) perspective and thus complement traditional outcomes measures. Due to their length, HRQL measures have rarely been incorporated into routine clinical practice for HIV-infected pts.
Methods: We assessed the validity of a single-item measure of HRQL against a full HRQL instrument among pts at all stages of disease attending an urban HIV specialty clinic (n = 267). Multivariate regression was used to examine associations between domain scores for the full HRQL instrument, the single-item measure, and clinical variables. We then examined HRQL using the single-item measure for all pts attending the clinic in 2001 (n = 821) and used logistic regression to assess the relationship between HRQL, CD4 cell count, HIV-1 RNA level, current opportunistic infection (OI) diagnosed within 30 days of assessment, and lack of potent combination antiretroviral treatment (pts who had not received treatment for 30 or more days), controlling for clinical and demographic factors.
Results: The single-item HRQL measure was significantly associated with all domain scores on the full HRQL instrument controlling for demographic and clinical factors (adjusted R2 0.42-0.69). The single-item measure distinguished pts at 3 levels of health status. In the adjusted analysis, pts with an HIV-1 RNA level > 100,000/ml were 2.2 times more likely to report poor general health on the single-item than those with an HIV-1 RNA level < 2,000/ml (95% CI, 1.03-4.9) and 2.8 times more likely to report fair health versus higher levels of health status (95% CI, 1.5-5.5). Pts with a current OI were 3.8 times more likely to report poor health than pts without a current OI (95% CI, 1.2-12.1) and 2.5 times more likely to report fair health versus higher levels of health status (95% CI, 1.4-4.4). Pts not receiving antiretroviral therapy were 2.2 times more likely to rank their general health status as poor versus fair compared to pts receiving antiretroviral therapy (95% CI, 1.2-4.0).
Conclusions: A single-item HRQL instrument is a valid measure of overall health status among HIV-infected pts in routine clinical care. High viral loads, symptom burden, current OIs, and not receiving antiretroviral therapy have significant adverse effects on patients’ quality of life.
