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. Castro3
1Institute 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.
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.
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