8th Conference on Retroviruses and Opportunistic Infections Chicago, IL - February 4 - 8, 2001

Conf Retroviruses Opportunistic Infect 2001 Feb 4-8; 8:188 (abstract no. 485)

Mannheimer S¹, Friedland G², Matts J³, Child C⁴, Chesney M⁴ for the CPCRA;
¹Harlem Hosp./Columbia Univ., New York, NY; ²Yale Univ., New Haven, CT; ³Univ. of Minnesota, Minneapolis; and ⁴Univ. of California at San Francisco.

BACKGROUND: Adherence to antiretroviral (AR) therapy predicts virologic outcome. The relations between AR adherence (adh) and quality of life (QOL) and QOL and HIV RNA have not been reported.

METHODS: Participants (pts) in CPCRA 057 and 058, randomized clinical trials comparing AR strategies in AR-experienced and -naïve pts, complete a confidential, 7-day recall adh self-report at 1, 4, 8 and 12 mos. Adh was classified as 100%, 80-99% and <80%. QOL was measured using SF-12 at baseline and the same time points. QOL scores were obtained by rescaling each SF-12 dimension (general health, mental, pain, physical, energy and social) from 0 to 100 (most favorable); e.g., responses of 1, 2, 3, 4, or 5 were converted to 0, 25, 50, 75, or 100, respectively. Analysis of variance was used to evaluate the data.

RESULTS: 726 pts completed 1 mo, 201 completed 12 mos follow-up as of 8/00; 20% women, 52% African Americans, 16% Latinos, 17% injection drug use history, mean age 39 yr. At baseline, median CD4 was 191 cells/mm³ and median plasma log HIV RNA was 4.9 copies/ml. Adh predicted virologic outcome (p<0.05). Pts reporting 100% adh had significantly higher QOL scores than pts reporting 80-99% or <80% adh. At 8 mos all 6 SF-12 dimensions were positively associated with adherence (p<0 .02); at 12 mo, general health and physical ratings of QOL remained associated with adh (p<0.01). The general health rating was associated with adh at all 4 time points (p<0.02); at 12 mos the average score was 65.7 for those with 100% adh, 63.5 for those with 80-99% and 50.0 for those with <80% adh (p=0.007). Baseline QOL did not predict future adh levels. After adjustment for adh, only the general health at mo 12 (p=0.001) and physical functioning dimension of QOL at mos 8 and 12 (p=0.007 & 0.01) remained associated with HIV RNA.

CONCLUSIONS: Self-reported antiretroviral adherence and quality of life are significantly associated, but their causal relationship is not clear. After adjusting for adh, fewer QOL dimensions remained associated with HIV RNA. Further research is needed to elucidate the nature and direction of the relationship among these measures and its bearing on therapeutic effectiveness.

2001-02-04
485

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