Abstract

Quality of life of people with HIV/AIDS receiving antiretroviral therapy in Cuba: a cross-sectional study of the national population

C. Aragonés¹, J. Pérez², J. Campos¹, M.C. Smith Fawzi³, Y. Khawja⁴, K. McPhillips⁵, A. Castro<sup>3

1</sup>Institute of Tropical Medicine ¨Pedro Kouri¨, Biostatistics and Informatics, Havana, Cuba, ²Institute of Tropical Medicine ¨Pedro Kouri¨, Hospital, Havana, Cuba, ³Harvard Medical School, Global Health and Social Medicine, Boston, United States, ⁴Albert Einstein College of Medicine, Bronx, United States, ⁵Albany Medical College, Albany, United States

Background: In Cuba, ART has improved immunologic parameters, increased survival, and diminished the occurrence of opportunistic infections and AIDS-related mortality. However, the effect of the provision of ART on the quality of life (QOL) of people with HIV/AIDS had not been studied quantitatively.
Methods: We conducted a cross-sectional study of the population receiving ART that included the administration of the MOS-HIV Health Survey Questionnaire to a representative sample of the 1,592 people receiving ART in Cuba in 2004. For univariate analyses mean scores were compared for MOS-HIV scales. Logistic regression models were used to estimate the association between pain and sex, role function and date of diagnosis, and health transition and region of diagnosis, adjusting for demographics, ART regimen, and clinical status. To our knowledge, it is the first quantitative HIV/AIDS study conducted with a representative sample of a national population.
Results: There were 354 participants (73 women, 281 men). Scores for all functional activities showed means above 80 out of 100. People using indinavir showed higher scores in perception of general health (58.9, 52.4; p=0.045) and health transition (78.6, 67.8; p=0.002). Pain interfered more in women than in men (73.2, 81.8; p=0.010). When HIV diagnosis occurred after 2001, both the probability of experiencing difficulties in performing work, study, or housework activities (OR=4.42; 95%CI=1.83-10.73) and of experiencing pain (OR=1.70; 95%CI=1.01-2.88) increased compared to earlier diagnosis; women had a higher probability of experiencing pain (OR=3.36; 95%CI=1.26-8.92) regardless of timing of diagnosis.
Conclusions: People diagnosed with HIV since ART became available in Cuba reported more pain and less cognitive functioning than those diagnosed earlier. Also, women are not enjoying the same health-related QOL as men. As the HIV epidemic evolves in Cuba and elsewhere, the most socially vulnerable are the most at-risk of becoming infected with HIV, even in a highly equitable setting.