Health-related quality of life and antiretroviral therapy in KwaZulu-Natal, South Africa

In studies conducted with African and Asian cohorts researchers have shown the clinical efficacy of antiretroviral therapy (ART) in resource-limited settings. However, studies on the longer term changes in health-related quality of life (HRQoL) with patients receiving ART in these settings are still scarce. The aim in this study was to assess HIV patients' HRQoL, clinical, psychosocial, and sociodemographic factors at 3 public hospitals in KwaZulu-Natal, South Africa over 20 months. Patients (N = 735) who attended 3 HIV clinics completed interview assessments prior to initiation of antiretroviral therapy; 519 after 6 months, 557 after 12, and 499 after 20 months on ART. Results indicate that total HRQoL increased, as did general quality of life, general health, independence, social relationships, and environment. HIV symptoms, depression symptom ratings, and internalized stigma reduced over time, whereas CD4 cell counts (number of helper T cells per cubic milliliter of blood), adherence to ART, and social support increased. Total HRQoL, the physical and psychological HRQoL domains, and internalized stigma improved at first and then deteriorated almost to baseline levels. Significant independent predictors of good HRQoL were low internalized stigma, being employed, earning wages, higher CD4 cell counts, and fewer and less severe HIV and depressive symptoms. In order to maximize gains in HRQoL for patients on ART, interventions are needed that address and reduce stigmatization and enhance the economic and employment opportunities.