Quality of life in persons living with HIV in a healthcare institution of 

Tijuana, MexicoJhonis Quintero1, David Goodman1, José Burgos1, Fátima Muñoz1, María 

Ibarra2, María Zuñiga1, 2

Affiliation: 1 University of California San Diego, 2 ISSSTECALI, Tijuana, MexicoFunding: AIDS International Training in Research Grant (1D43TW008633‐01)

Sixth Annual CFAR International HIV/AIDS Research DaySeptember 18, 2012

INTRODUCTION

• Health‐related quality of life (HRQoL) multidimensional concept.– Physical and social functioning, mental health, pain and energy (Briongos et al, 2011).

• HIV chronic disease, HRQoL important healthindicator (Valencia et al, 2010).

BACKGROUND• HIV prevalence in Mexico 0.3 %.

– HIV prevalence in Tijuana 3 times the national average in the general population (Brouwer et al, 2006).

• No previous studies exploring HRQoL amongHIV patients in México.

Studies HRQoL (mean, SD) using MOS‐HIV*

Briongos et al, 2011 (Spain) PHSa 52.3 (8.8)

MHSb 49.3 (9.9)

Perez et al, 2005 (Spain) PHSa 50 (10.6)

MHSb 50 (9.6)

Miners, et al, 2004 (London) PHSa 41.8 (13.2)

MHSb 43.2 (12.2)

*MOS‐HIV: Medical Outcomes Study HIV Health SurveyaPHS: Physical Health Score. bMHS: Mental Health Score

OBJECTIVES

• Explore HRQoL in patients receiving HIV carein a government health care institution inTijuana Mexico.

• Determine the association betweensociodemographic and clinical variables withHRQoL.

METHODS• Cross‐sectional study.• Target population: HIV infected adult patientsreceiving care in a government hospital inTijuana, Mexico (ISSSTECALI).

• Recruitment period: Nov 2010 ‐ June 2011.

• Medical ServicesInstitute for B.C. State workers.

• 4.16 % of state healthbeneficiaries. 

bajacalifornia.gob.mx. 2009

METHODS

• Total 54 patients were selected.• Approaching: consultation with medical doctor.• Investigation instrument: Disease‐specificMedical Outcomes Study HIV Health Survey(MOS‐HIV) instrument (Wu et al).

• Sociodemographic data was collected using astandardized questionnaire.

• Clinical variables were obtained throughelectronic record of hospital.

Summary of MOS‐HIV Survey ConceptsDimensions Explanation

Physical Functioning Physical activities (eating, dressing, bathing)Role Functioning Problems with work or daily activities

Pain No‐severe painGeneral Health Perceptions Views personal health

Social Functioning Limitations social activitiesEnergy Tired/energetic

Mental Health Nervous, depressed/calm, peaceful, happyHealth Distress Despair, discouraged, afraid due health

Cognitive Functioning Concentrating, reasoning, rememberingQuality of life Life bad/good, could hardly be worse/better

Adapted from MOS‐HIV Health Survey, Users manual. Wu. 1996‐99

Physical HealthSummary (PHS) score

Role Fn

PhysicalFn

Pain

Mental Health Summary(MHS) score

QoL

MentalHealth

Healthdistress

CognitiveFn

EnergyGeneral Health Social Fn

Revicki, Sorensen and Wu, 1998

MOS‐HIV Dimensions

ANALYSIS• Descriptive statistics: Means, standard deviation (SD),proportions.

• Student‐t test, ANOVA were used to identifyassociations between sociodemographic and clinicalvariables with PHS and MHS (dependent variables).

• Multivariate linear regression model.– Variables attaining p<0.20 in univariate analysis wereconsidered in the final model.

– Backward stepwise linear regression; variables withsignificance p<0.05 were retained.

• Data were analyzed using SPSS v20.0 (IBM).

ENROLLMENT 62 eligibleparticipants62 eligibleparticipants

54 participants wereincluded in the

analysis

54 participants wereincluded in the

analysis

3 decline toparticipate

5 could not be found

3 decline toparticipate

5 could not be found

Sociodemographic characteristics N (%)

Characteristic

Gender (male) 45 (83.3)

Age (mean, SD) 44.0 (9.4)

Marital status 

Single 29 (53.7)

Married 19 (35.2)

Common law relationship 4 (7.4)

Widowed 2 (3.7)

Sexual orientation

Heterosexual 30 (55.6)

Homosexual 20 (37.0)

Bisexual 4 (7.4)

Education

Primary school 19 (35.2)

High school 13 (24.1)

University 22 (40.7)

Clinical characteristics  N (%)

History injection drug use 5 (9.2)

Years since HIV Diagnosis (mean, SD) 6.5 (4.5)

Years on antirretroviral tratment (ART) (mean, SD) 4.9 (4.0)

All Comorbilities 29 (53.9)

ART regimen

First line (Mexico*) 45 (83.3)

Not first line 8 (14.8)

No treatment 1 (1.9)

T CD4+ Lymphocyte count (mean, SD) 720.5 (599.4)

<200 cells/μm3 2 (3.7)

200‐499 cells/μm3 18 (33.3)

>500 cells/μm3 34 (63.0)

Viral load, log (mean, SD) 2.0 (0.9)

Viral load, categories

<40 copies/ml 39 (72.2)

41‐1000 copies/ml 8 (14.8)

>1000 copies/ml 7 (13.0)*CENSIDA Guideline 2012

Mean Scores for the MOS‐HIVDomains Mean Median SD

Physical Health Summary Score  56.6 57.2 5.7

Mental Health Summary Score  56.9 58.2 13.1

Dimensions

Pain 88.3 100 19.4

Physical Functioning 87.2 90 13.5

Role Functioning 89.3 100 20.1

General Health Perceptions 78.7 80 17.4

Social Functioning 92.4 100 19.9

Energy 77.0 80 15.1

Mental Health 77.6 80 16.5

Health Distress 82.2 80 18.3

Cognitive Functioning 80.0 80 19.6

Quality of Life 84.1 80 14.7

Univariate Analysis for Sociodemographic Variables Category N 

(%)PHS

(Mean, SD)p

valorMHS

(Mean , SD)p valor

Gender

Female 9 59.1 (3.0) .15 55.7 (5.1) .65

Male 45 56.1 (6.09 57.1 (8.7)

Age

18‐44 y 30 56.0 (6.5) .39 57.0 (9.1) .90

> 45 y 24 57.3 (4.49 56.7 (7.3)

Marital  status

Single 29 55.6 (6.9) .55 54.9 (5.6) .04

Married 19 58.0 (4.2) 59.4 (5.6)

Widowed 2 55.9 (1.1) 48.8 (4.7)

Common law relationship 4 57.3 (0.8) 63.7 (2.7)

Sexual orientation

Heterosexual 30 57.9 (3.7) <.001 58.1 (5.8) <.001

Homosexual 20 56.7 (5.0) 58.0 (7.2)

Bisexual 4 46.2 (10.9) 41.7 (14.6)

Univariate Analysis for Clinical VariablesCategory N 

(%)PHS

(Mean, SD)p

valorMHS

(Mean, SD)p

valor

ART regimen

First line (Mexico) 45 56.6 (5.7) .61 56.0 (1.3) .22

Not first line 8 57.3 (5.9) 61.5 (6.0)

No treatment 1 51.2 58.8

Comorbilities

Yes 29 55.4 (6.7) .11 54.7 (9.7) .03

No 25 57.9 (3.8) 59.4 (5.3)

T CD4+ Lymphocyte count

<200 cells/μm3 2 45.0 (16.6) <.01 43.1 (29.8) .04

200‐499 cells/μm3 18 56.5 (4.9) 56.3 (5.9)

>500 cells/μm3 34 57.3 (7.3) 58.0 (7.2)

Viral load

<40 copies/ml 39 57.6 (4.5) .10 54.1 (9.1) .14

40‐1000 copies/ml 8 54.1 (9.1) 51.7 (13.5)

>1000 copies/ml 4 53.8 (5.9) 56.5 (6.8)

Final multivariate linear regression modelsLinear regression for Physical Health summary scoreVariable B SE IC95% P

Sexual orientation a ‐4.2 1.0 ‐6.3, ‐2.0 <.001Years since diagnosis 0.4 0.2 0.1, 0.7 .01Viral load (log) ‐2.6 0.7 ‐4.1, ‐1.1 .001Intercept 65.5 2.1 61.3, 69.7

Linear Regression for Mental Health summary scoreVariable B SE IC95% P

Sexual orientation a ‐5.3 1.5 ‐8.4, ‐2.2 .001ART regimen b 3.6 1.3 1.0, 6.2 .007T CD4+ Lymphocytesc 4.4 1.7 0.9, 7.8 .014Intercept 45.9 6.0 33.9, 57.9aSexual orientation: Heterosexual (reference), homosexual, bisexualBART regimen: First line (reference), not first line according to Mexican guidelinesCT CD4+ Lymphocytes: <200 (reference), 200‐499, >500

LIMITATIONS

• Small sample size.• Not representative to all HIV infectedpopulation in Tijuana, B.C. Mexico.– High socioeconomics status.

• Social desirability bias.• Cross sectional.

– Temporal association cannot be ascertained.

CONCLUSIONS

• Our study shows that the summary scores werehigher than those reported from other countries(Briongos et al, 2011. Perez et al, 2005. Miners, et al, 2004).

• Sexual orientation, still affecting HRQoL, may berelated with stigma.

• Years since diagnosis, increases HRQoL, probablybecause late start ART.

• ART regimen affects HRQoL, related with newest ART.• Positive relation between TCD4+ and HRQoL.• Negative tendency between viral load and HRQoL.

IMPLICATIONS

• HRQoL must be considered multidimensional,to modify and improve health in thesepatients.

• HRQoL monitoring should be incorporated instandard HIV care in Mexico.

• Prospective studies are needed to betterunderstand factors related to HRQoL.

ACKNOWLEDGEMENT

• Dr. Goodman, Dr. Burgos, Dr. Muñoz, Dr. Ibarra, Dr. Zuñiga, Dr. Strathdee.

• AIDS International Training and Research Program (AITRP).

• Hospital ISSSTECALI, Tijuana.• Center for AIDS Research (CFAR).