武汉市HIV/AIDS患者抗病毒治疗前后生存质量及影响因素纵向研究

Quality of life and related factors of HIV/AIDS cases with the time of receiving highly active antiretroviral treatment in Wuhan:a longitudinal cohort study

目的探究武汉市HIV/AIDS患者ART前后生存质量变化及其影响因素。方法选取2013年6月至2014年10月在武汉市艾滋病抗病毒治疗定点医院准备接受ART的HIV/AIDS患者为研究对象,采用前瞻性纵向研究设计,使用世界卫生组织艾滋病生存质量简表(WHOQOL-HIV BREF)对其治疗后4年内的生存质量进行重复测评。结果本研究共纳入330例HIV/AIDS患者,1年期和4年期随访调查完成率分别为92.73%和90.30%。研究对象在不同治疗时期生理领域、独立性领域、社会关系领域、环境领域、总体生存质量及生存质量总分差异有统计学意义(P均<0.05);精神/支柱/个人信仰领域得分在抗病毒治疗1年期显著提高,而后趋于平稳;心理领域得分在抗病毒治疗1年期无显著变化,但在治疗4年期显著提高。文化程度、婚姻状况、经济收入、样本来源、治疗机构和基线CD4细胞水平是影响生存质量变化的主要因素。结论持续接受ART是提高HIV/AIDS患者生存质量的有利因素,在ART初期应加强心理干预,重点关注文化程度低、离异或丧偶、低收入水平者,充分发挥社会组织作用,倡导个案管理模式,动员患者尽早接受ART,可持续提高HIV/AIDS患者生存质量。

Objective To explore the change of quality of life(QOL)and its related factors among people living with HIV(PLWH)before and after receiving the highly active antiretroviral treatment(HAART)in Wuhan.Methods From June 2013 to October 2014,we recruited PLWH who were ready to receive HAART in the designated hospital in Wuhan.A prospective longitudinal study design was applied to assess QOL within 4 years of treatment using the WHO quality of life questionnaire for HIV brief version(WHOQOL-HIV BREF).Results A total of 330 PLWH were recruited in the study.92.73%and 90.30%of participants completed 1-year and 4-year follow-up surveys,respectively.There were statistically significant in differences in the domain of physiology health,independence,social relations,environment,overall QOL,and total score of QOL in different periods of HAART(all P<0.05).Statistically significant improvements in the domain of physiology health,independence,social relations,environment,overall QOL,and total score of QOL were observed at different duration of HAART.The spirituality/personal/beliefs domain scores increased significantly between baseline and 1 year and plateaued between 1 and 4 years.The differences were not statistically significant in the domain of psychological health between baseline and 1 year but showed further significant improvement at 4 years of follow-up.Education,marital status,incomes,sample sources,treatment facility and baseline CD4 cells were the factors affecting the change of QOL.Conclusions Sustainable HAART is beneficial to improve the QOL of PLWH in Wuhan.Psychological intervention should be strengthened during the early treatment.We also need to pay more attention to those with low educational level,divorced or widowed and with low incomes.Giving full play to the role of social organizations,advocating case-management model,and mobilizing cases to receive HAART as soon as possible could continuously improve the QOL among PLWH in Wuhan.