Relationship between CD4 count, viral load, and quality of life in HIV-infected patients on HAART attending a primary healthcare setting in South Africa

Background: Biomedical markers remain major measures of HIV/AIDS disease-progression and well-being of people living with HIV (PLWHA) on treatment. It is important to measure health related quality of life (HRQOL) in PLWHA since HIV/AIDS is an incurable chronic disease. Adherence to Antiretroviral therapy (ART) enables PLWHA reach and maintain viral-suppression, reducing risk for secondary-transmission.  Aim: Determine relationship between biomedical-markers and HRQOL among PLWHA on HAART. Method: A cross-sectional study was conducted in 100 HIV-infected attending an HIV-clinic. Sociodemographic-data were collected using standardized-questionnaire and HRQOL data using WHOQOL-HIV-BREF questionnaire. Biomedical-markers were obtained from patient’s medical-records; ART-adherence from pill-count method. Data were analysed using SPSS-22 for basic descriptive. Independent-samples-test and ANOVA were used to determine significant differences at P ≤ 0.05.  Results: Of 100 participants interviewed, 63% were females, and 37% males with mean-age of 38 years  with 36% in age-range 31-40years. Of these, 47% had secondary-education, 20% were contract- employees, 32% receiving ≥ZAR10000 monthly, 55% living in rural-areas and 42% were singles. Good health-status was reported in 92%, 73% had initial-CD4-count ≥500cells/mm3, 54% had initial-viral-load ≥10000copies/mL and 98% undetectable. Asymptomatic patients were 62% and 43% had WHO-clinical-stage-2. Only 24% had acceptable adherence-rate of ≥ 90%. A significant-association was observed between initial-CD4-count and employment-type (F = 4.0905, P = 0.029); income-earned (F = 7.131, P = 0.010);  and HIV-status ((F = 4.758. P = 0.032), then initial-viral-load with gender (F = 15.362, P <0.001); educational-level (F = 5.037, P = 0.027) and HIV-status (F = 4.806, P = 0.031). Highest-mean-scores (77.00±14.94) were obtained in environmental and lowest (26.25±26.44) in spiritual/religious/personal beliefs (SRPB) domains. A significant association was between initial-CD4-count and SRPB domain  (F=5.473, P = 0.021). There was no association between WHOQOL-HIV domains and initial and current viral loads. Neither was an association between biomedical markers and adherence rates of study participants. Conclusion: Results reveal no relationship between biomedical-markers and HRQOL in PLWHV. These biomedical markers alone may be inadequate eligibility criteria for social support. Therefore, monitoring these markers should be underscored in the management of HIV patients on HAART. PLWHA on ART will consistently have a huge impact on QOL.