Health-Related Quality of Life in Patients with Human Immunodeficiency Virus Infection in the United States: Results from the HIV Cost and Services Utilization Study [Hays RD, et al. Am J Med 2000; 108: 714]: This is another report from the HIV Cost and Services Utilization Study (HCSUS), which is an AHCR-sponsored study done by Rand that is based on a national sampling of persons in medical care for HIV infection. The current report is an analysis of interviews of 2,864 HIV-infected adults with queries in eight domains of health: physical functioning, role functioning, general health perception, emotional well-being, energy and disability days. In the category of physical functioning, patients with asymptomatic HIV performed on par with the general population showing a mean score of 92 versus 90, respectively. However, persons with AIDS had a score of 58 indicating severe impairment that was comparable to the score reported for patients with end-stage renal disease. In the category of emotional well-being, there was little difference for those with HIV infection based on stage of disease, but the entire group scored significantly lower than the general population or patients with other chronic diseases except for general depression. The authors concluded that there is substantial morbidity associated with HIV disease, and this needs to be included in those who plan policy and allocation of resources.
Comment: Providers of HIV care will not be surprised by the results of this analysis which shows that while patients with asymptomatic HIV infection have no apparent limitations in physical functioning, there are substantial reductions in functioning in those with symptomatic HIV infection and AIDS. The same result was found for emotional well-being, which was substantially lower than in patients with diabetics, prostate cancer, epilepsy, or end-stage renal disease. The comparison with other chronic diseases is interesting and should provide an appropriate framework for health policy and resource allocation. Particularly important is the observation of reduced physical capacity in patients who have symptomatic HIV infection but have not progressed to AIDS. posted 8/11/2000