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php/icmahs An Updated Review Of The Literature On The Factors Influencing The Health-Related Quality Of Life Of Those Living With Hiv Gusti Ayu Krisma Yuntari1,2.
Cokorda Bagus Jaya Lesmana3.
Putu Eka Arimbawa4,5 Doctor of Medicine Programme.
Faculty of Medicine.
Udayana University.
Bali.
Indonesia RSUD Sanjiwani Kabupaten Gianyar.
Bali.
Indonesia Psychiatric Department,Faculty of Medicine.
Udayana University.
Bali.
Indonesia Clinical Pharmacy Study Program.
University Bali International.
Bali.
Indonesia Public Health Center Karangasem I.
Bali.
Indonesia Corresponding author: krismayuntari@gmail.
Article history Posted :
Reviewed :
Received :
2024-12-12
2024-10-29
2024-10-03
ABSTRACT
Background : HIV(Human Immunosuficiency Viru.
has evolved into a chronic disease and one of the important indicators assessed in chronic diseases is quality of life.
Literature discusses various factors that influence quality of life, but there is currently no consensus on the main determinants.
Methods :
All studies published fromA.
until 2023 that identified determinants factor of quality of life among peole living with HIV were considered in this narrative review.
Pubmed.
Web of Science, and Google Scholar using the keywords.
AodeterminantAo.
Aoquality of lifeAo and Aopeople living with HIVAo.
Validated measures must be utilized, and studies must report overall scores as well as physical or mental health Additionally, mutivariate analysis must be performed to determine the factors that independently affect perceived quality of life.
Result: A total of 14 studies using a range of HRQOL assessments were included for additional analysis: RAND Short Form 36 (SF-.
WHOQOL-HIV-BREF.
Medical Outcomes Study-HIV.
Euro QoL, and PROMIS Global 10.
The review categorizes the discussed determinants into three themes: socio-demographic, clinical, and psychological components.
Conclusion: Quality of life in PLHIV(People Living With HIV) is influenced by many concurrent factors.
Various instruments can be used to assess quality of life and all have limitations.
Based on the research examined here, we can reach the conclusion that clinical and disease-related factors, psychological factors, and sociodemographic factors all have an impact.
Keywords :
HIV.
Quality of life.
Determinant Factors.
Review
Gusti Ayu Krisma Yuntari et all : An Updated Review Of The Literature On The Factors Influencing The HealthRelated Quality Of Life Of Those Living With Hiv
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php/icmahs Introduction According to estimates from the (World Health Organization, 2.
(WHO), 37.
9 million persons globally are HIV positive at the moment.
By 2030, the Global AIDS Strategy 2021Ae2026 of the Joint United Nations Programme on HIV/AIDS (UNAIDS) seeks to put an end to the pandemic as a hazard to public health(World Health Organization, 2.
With the advent of combination antiretroviral medication, among other significant advancements in HIV treatment, the virus is no longer considered a life-threatening illness but rather a chronic one.
Nonetheless, there is still a great deal of stigma associated with being HIV positive(Xu et al.
The new approach takes a more comprehensive, multifaceted approach than the current response framework, which emphasizes testing, treatment, and viral suppression.
person-centered disparities and advance well-being.
Although viral suppression is still a vital target, it shouldn't be the only primary endpoint.
HIV
care in a spiral.
Numerous HIV-positive individuals (PLHIV), continued to feel symptoms despite being virologically suppressed HRQoL (Health-Related Quality Of Lif.
was considerably worse compared to the average populace(Xu et al.
, 2.
It is believed that HRQoL comprehending the impact of HIV as a chronic illness(Miners et al.
, 2.
According to the World Health Organization, a person's view of their place in the culture and value systems in which they live, as well as in respect to their objectives, standards, expectations, and worries, constitutes their quality of life (QoL)(World Health Organization.
, 1.
Data on HRQoL can be utilized to pinpoint inequalities among various populations and to guide measures that will guarantee long-term care retention.
ART adherence, and maintenance of excellent health(Lazarus et al.
, 2.
The 90-90-90 targets, which are for HIV treatment, are that 90% of patients know their status, 90% of those on ART experience viral suppression, and 90% of those on ART receive These targets are set by the United Nations Programme on HIV/AIDS (UNAIDS) (Lazarus et al.
, 2.
Nonetheless, patients' psychological, social, and financial demands have received scant consideration (Mengistu et , 2.
Diverse authors have presented differing findings about the incidence of HRQOL among HIV/AIDS patients in various parts of the Method A reviewof the narrative was performed with a global search strategy through Pubmed.
Web of Science, and Google Scholar using the (Mes.
Aodeterminant* AND quality of life OR HRQOL Or Health-related quality of life AND HIV OR people living with HIVAo.
The reviewed articles are :
Examining the HRQOL of adults with HIV Release prior to August 2023 English text available in its entirety Reporting HRQOL as a combined score, a physical and mental score, or both Making use of a verified HRQoL tool Using multivariate regression analysis and quantitative technique to determine the factors that influence HRQoL We checked the abstract and title to make sure those standards were met.
If all inclusion requirements were met, the paper was thoroughly read.
if not, this was still not By looking through the references in the manuscripts, further material was found .
nowball approac.
Four kinds of variables were created a Gusti Ayu Krisma Yuntari et all : An Updated Review Of The Literature On The Factors Influencing The HealthRelated Quality Of Life Of Those Living With Hiv
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php/icmahs sociodemographic, and clinical determinants.
These criteria were selected through comparison with HRQoL research that was Manuscript results and conclusions were assigned to one or more determinants.
addressing each determinant independently and reviewing all papers that were pertinent to the determinant, the review was further Fig 1.
A flow chart of Narative Review Result In total 14 studies were included for further analysis shown in table 1.
These studies were conducted between 2017 And 2023 in countries such as the United Kingdom (UK).
Pakistan.
Finland.
Nigeria.
China.
Romania.
Spain.
Indonesia.
India and Ethiopia.
The instruments used to measure Medical Outcomes Study HIV Health Survey.
HRQoL, and WHOQOL-HIV Bref.
Determinants in each country are different based on Economic Stability.
Healthcare Access and Quality Education and Health Literacy Environmental Determinants Social and Cultural Factors.
Table 1.
Results 14 studies were included for further analysis Authors Country Year Sample Size Jose Catalan.
London, et al.
Shriharsha.
Karnataka, 2019 450
et al
India
PLHIV
PLHIV
Study Design
Instrument Result of For Determinant Factor
QoL
Cross
WHOQOL- C Everyday
Sectional HIV-BREF
C Anxiety Cross
WHOQOL- C Male Gender
Sectional HIV-BREF
C Being Graduated C Not Knowing the mode of Gusti Ayu Krisma Yuntari et all : An Updated Review Of The Literature On The Factors Influencing The HealthRelated Quality Of Life Of Those Living With Hiv
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php/icmahs Abel Legesse Ethiopia
Tesemma, et
PLWH
Cross WHOQOLSectional HIV-BREF Leonard Emuren.
Hua Zhong.
Sichuan, et al
China
USA
PLHIV
Nested Cohort
PLHIV
Cross Sectional RAND Short Form 36 (SF-.
MOS-HIV
Nancy Kupang.
Indriyani Indonesia Dida, et al Nuno Nobre.
Finland
et al
PLHIV
Cross
WHOQOLSectional BREF
2017 453 HIV Cross
WHOQOL
infected Sectional HIV-BREF Bello Zaria.
Abdullahi Nigeria Suleiman, et Ali Ahmed.
Pakistan et al
HIVPositive PLHIV
Cross
WHOQOL
Sectional HIV-BREF
Corss
Euro QOL
Sectional C
CD4 Count
Absence Normal Body Mass Index
Social Support
No Perceived CD4 Count
Medical and Mental
Education Younger age
CD4 Count
Symptom
Counts Health
BMI
Stigma
Stress level Male gender
Being Married Being Not Having Medical Commorbiditie Spousal HIVPositive status
High
Family Function
Female Gender
Age
Education Level Gusti Ayu Krisma Yuntari et all : An Updated Review Of The Literature On The Factors Influencing The HealthRelated Quality Of Life Of Those Living With Hiv
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php/icmahs HIV Serostatus
AIDSConverted C CD4 Count
C Viral Load
C Increase time
to ART
Delelegn
Ethiopia
2018 520 HIV Cross
WHOQOLC Family support
Yilma G, et al
Patients sectional HIV BREF
C Educational Occupation Solomon
East
Cross
MOS-HIV
C Self
Ahmed
Ethiopia
PLHIV
Sectional Health Employment Mohammed.
Survey C CD4 Counts et al C 6 Ae 10 years Sri Malang.
Cross
WHOQOL
C Being older
Sunaringsih
Indonesia
PLHIV
Sectional HIV-BREF
C Having a job
Ika W, et al
C Having better
acces to health
C Adhering C ART program
C Stigma
C Social support
Fikadu
South
Cross
PROMIS
C Age
Tadese Africa
PLHIV
Sectional Global 10 C Employment Nigusso, et C Comorbidities Gender variations in mental diseases may Socio-demographic characteristics potentially contribute to variances in HRQoL There was no consensus regarding the between the sexes.
The higher prevalence of genders(Degroote et al.
, 2.
Women mostly mood, anxiety, and psychosomatic problems in reported lower HRQoL than men (Lowther et al.
women may be a factor in the disparity in Women reported a high number and HRQoL.
On the other hand, some research severity of adverse events, higher pill burden, indicated that women reported superior and lower scores in all three domain QOL general or mental health.
The results were domains than men (Mokgethi et al.
, 2.
One explained by suggesting that the sample had a possible explanation for the fact that women higher percentage of worried men and better with HIV often had to shoulder the load of coping mechanisms in women(Mrus et al.
raising children could be the reason why they scored worse than men(Mrus et al.
, 2.
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php/icmahs Physical health was generally worse in older adults(A.
Ahmed et al.
, 2.
Age-related declines in HRQoL are consistent with findings from research conducted in France, the United States, and Brazil(Castro et al.
, 2.
(Emuren et , 2.
Memory problems, anxiety and despair, gender, ethnicity, family dynamics, and economic circumstances have all been linked to a lower quality of life in people over 50 (Catalan et al.
, 2.
As they get older.
HIV patients are more prone to experience comorbidities, opportunistic infections, and medication nonadherence, all of which lower their overall quality of life(Devlin & Brooks, 2.
Socio economic: Employment and education The result of this study is unemployed individuals had poor quality of life (S.
Ahmed et , 2021.
Mrus et al.
, 2005.
Wardojo et al.
Employment could boost social networking and support, as well as providing more financial resources.
One likely needs to be in better health in order to be employed, and therefore(Wardojo et al.
, 2021.
Having a job may help one integrate more socially and achieve a higher socioeconomic standing, which in turn supports better possibilities for social environment and health promotion and maintenance(Igulot & Magadi, 2.
HRQOL and education have also been related, however the relationship is weaker(A.
Ahmed et al.
, 2.
It is not unexpected that higher educational status may result in a worse quality of life because patients with formal education may know more about their illness, linked opportunistic infections, medication, and how to take It(Arrey et al.
, 2.
Greater levels of education may improve a person's ability to deal with HIV and increase patient awareness of the illness (Nobre et al.
, 2.
Family situation The HRQOL was low for the .
on-supportiv.
Numerous studies have documented the importance of family support in enhancing the quality of life for individuals living with HIV/AIDS(Gebremichael et al.
, 2018.
Suleiman et al.
, 2.
This outcome could be explained by the possibility that psychological support increases personal happiness and has a beneficial overall impact on healthy eating, selfcare, and overall health(Gebremichael et al.
A healthy, loving family can help the patient in many ways, including socially, spiritually(Suleiman et al.
, 2.
The family environment offers security, stability, and financial support.
Living with their family, therefore, is likely to result in greater social support, tighter interpersonal relationships, and satisfying sexual activityAiall of which have a beneficial effect on HRQOL(Suleiman et al.
Factors connected to clinical and disease statesImmunological and virological condition An increase in CD4 lymphocytes and an improvement in physical HRQoL.
In a similar vein, other research has indicated that the count of CD4 cells is a significant predictor of other aspects of quality of life(Chatterjee et al.
Cooper et al.
, 2.
However, because their baseline physical state was worse, patients who started ART at CD4 <200 cell/AAl saw a greater improvement in their physical health than patients who started at 200Ae350 cell/AAl or >350 cell/AAl(Degroote et al.
, 2.
Cd4 cells are a strong marker for disease progression(S.
Ahmed et al.
, 2.
and can reflect the impact of theraupetic efforts(Zhong et al.
, 2.
Due to their low CD4 count and weakened immunity.
PLWH are more likely to be afflicted by numerous opportunistic infections, which ultimately lowers their quality of life(Tesemma et al.
, 2.
Sympton counts Gusti Ayu Krisma Yuntari et all : An Updated Review Of The Literature On The Factors Influencing The HealthRelated Quality Of Life Of Those Living With Hiv
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php/icmahs HIV symptoms have also been linked to a lower quality of life, and more severe problems may worsen this relationship(Zhong et al.
, 2.
The symptoms that were most frequently described were joint discomfort, weariness, sleep difficulties, amnesiaand dry mouth(Zuyiga et al.
, 2.
(Huang et al.
, 2.
The symptoms are influenced by numerous circumstances, including the impact of AIDS on the immune system(Zuyiga et al.
, 2.
adverse effect of medication(Bruno et al.
, 2.
and psychosocial factor(Voss et al.
, 2.
ART and Having Better Access to Health Service Most recent research has demonstrated that ART improves quality of life.
It has been said that the impact of antiretroviral therapy (ART) on quality of life is a trade-off between less HIV-related symptoms and longer life expectancy on the one hand, and adverse drug reactions on the other(Degroote et al.
, 2.
The QoL of PLHIV is greatly influenced by medication adherence and access to healthcare services(Garcya-Goyi et al.
, 2.
In a similar vein, people who had been on antiretroviral therapy (ART) for more than a year and who had not missed any doses also seemed to be in better health(Wardojo et al.
, 2.
Comorbidity Two studies (Emuren et al.
, 2017.
Nobre et al.
, 2.
examined the impact of comorbidities on PLHIV QoL.
These studies were done in Finland and USA at 2017 to 2020.
Crosectional design was adopted in each of the Medical co-morbidities cardiovascular disease, cancer and other chronic medical conditions(Emuren et al.
Other medical co-morbidities add to the strain and have a detrimental effect on social relationships and quality of life(Serryo et al.
Psychological Factors Two studies examined the impact of the anxiety and depression on PLHIVAos QoL.
These studies were done in.
Ethiopia and UK.
According to an Ethiopian study, participants without depression had a 10.
59-fold higher likelihood of having a good quality of life than those with depression(Tesemma et al.
, 2.
PLHIV experience anxiety issues more frequently than the general population doesand anxiety is known to be linked to symptoms of depression(Catalan et al.
, 2.
According to our research, four studies examined how PLHIV's partner's HIV status affected their quality of life.
These studies were done in Indonesia.
Nigeria.
Ethiopia and Pakistan.
The findings demonstrate that the high domain scores obtained in the areas of social, environmental, and degree of independence are indicative of the excellent caliber of care provided to these patients.
Study Research conducted in Ethiopia indicates that individuals with strong social support were 6.
times more likely to report a high quality of life compared to those without such support (Tesemma et al.
, 2.
Discrimination and stigmatization usually make it difficult for PLHIV to get the assistance and support they need(Wardojo et al.
, 2021.
Compared to people who sensed stigma, those without stigma had a 2.
75-fold greater odds ratio of having a good quality of life(Tesemma et al.
PLWH will be subject to stigma from both the community and their family, which is manifest in the form rejection, neglect and discrimination(Dida, 2.
Discussion The concept of quality of life is multifaceted and contingent on sociodemographic, clinical and psychological factor that associated with quality of life on PLWH.
The majority of cross-sectional studies using a variety of instruments to measure quality of life comprised the literature about quality in PLHIV.
Gusti Ayu Krisma Yuntari et all : An Updated Review Of The Literature On The Factors Influencing The HealthRelated Quality Of Life Of Those Living With Hiv
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php/icmahs Individuals who are HIV positive frequently face a variety of issues related to their health and social standing(Aidala et al.
, 2.
Gender, age, employment and education, family situation are four of the most important sociodemographic determinant factor of quality of life among PLHIV.
A minimun level of income because unemployment showed a negative impact on quality of life.
The impoverished PLHIV are typically thought to be less educated, and their lack of access to social networks and support systems may provide a number of difficulties.
People with less education and experience are less equipped to deal with the consequences of HIV/AIDS infection and adopt healthy coping mechanisms(Ghiasvand Demographically, being under 35 years old was positively and directly correlated with PLHIV QoL.
This could be associated with younger people having higher levels of physical stamina and strength.
Factors like age may have an impact on physical health as a component of quality of life(Degroote et al.
, 2.
It's unclear if age and mental health or other aspects of QoL among PLHIV are related, and more research may be necessary.
Ensuring therapy is available and accessible along with appropriate counseling strategies is necessary to ensure adherence and motivate individuals using ART to complete their treatment (Mutabazi-Mwesigire et al.
The impact of antiretroviral therapy (ART) on quality of life has been presented as a balance between drug side effects and improved life expectancy and reduced HIVrelated symptoms in one area (Liu et al.
, 2.
ART treatment was independently linked to improved physical health, while stopping ART treatment was linked to worse mental health.
People with CD4 counts this low are typically diagnosed with HIV/AIDS.
When the CD4 count is less than 200 at this point, the infection shows clear symptoms.
When the infection reaches stage 4, with physical and visible manifestations, the asymptomatic stage of the infection transforms into the symptomatic stage, and The WHO's HIV/AIDS infection stage system states that we can watch the progression of an HIV infection turningllness(Bettmann & Hunink.
Higher CD4 counts were found to have a beneficial effect on quality of life in another review study, however the researcher noted that this link might not be causal.
They also concluded that starting antiretroviral therapy (ART) in patients with lower CD4 counts results in improved outcomes and that medication adherence lasting more than a year may enhance quality of life(Degroote et al.
, 2.
Medical professionals must take the patients' needs into account at this time, and ART should proceed with a greater emphasis on the other co-morbidities and disorders that the patients are dealing with.
Controlling esophageal and oral infections, tuberculosis, sarcoma, and other concurrent diseases is essential for treating patients at this stage.
This treatment strategy could greatly benefit the patients by assisting in managing their health state and, in turn, their quality of life (Owiti et , 2.
Comorbidity and opportunistic infections are two difficult features of maintaining and controlling HIV among the diagnosed population.
These infections could worsen patients' health issues and lower their quality of life.
According to our study, the availability of services and the timing of diagnosis have a beneficial impact on PWLHs' quality of life.
Early HIV/AIDS diagnosis and the development of timely therapy with patients may help in managing and controlling the By empowering them with practical coping mechanisms and boosting their resilience, this can improve PWLHs' quality of This study's key finding is that stigma connected to HIV is linked to higher degrees of melancholy and poorer levels of social support.
These findings corroborate those of a previous
meta-analysis regarding the relationship
Gusti Ayu Krisma Yuntari et all : An Updated Review Of The Literature On The Factors Influencing The HealthRelated Quality Of Life Of Those Living With Hiv
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php/icmahs between HIV-positive individuals' health, demographics, and stigma(Rueda et al.
, 2.
Fewer research, meanwhile, has been done on the long-term relationships between HIVrelated stigma and social support or depression.
Additionally, there was some research looking at how stigma connected to HIV and depression may interact with other types of stigma, like homophobia, racism, and gender discrimination.
Previous research on the interaction between HIV-related stigma and social support suggests that disclosing one's HIV status to family, friends, or healthcare professionals may be a stigmatizing social process that might induce fear of rejection or isolation and exclusion by support networks(Rueda et al.
, 2.
This review also found evidence of a connection between HIV-related stigma and poor health outcomes, including noncompliance with antiretroviral therapy and utilization of social and health services.
This is a narrative review, and there are certain restrictions on the approach.
There was inadequate documentation of the literature search, and there's a chance that some research were included out of personal bias.
However, we have reported transparently on the research methodology and have sought to write as comprehensive and coherent a review as Conclusion PLHIV's quality of life is impacted by numerous interrelated variables.
There are several tools available for evaluating life quality, but each has its own set of drawbacks.
Based on the research examined here, we can draw the conclusion that clinical and disease-related sociodemographic factors all have an impact.
Effort should be made for a comprehensive treatment in PLHIV to enchance their QoL.
therefore recommended to routine counselling, strengthening the peer support , ease of access to healtcare facilities and developing theraupetic actions regarding their illness to improve PLHIVAos QoL.
Conflict Of Interest All authors declare that they have no conflicts of interest.
Acknowledgement None
References