The association between Antiretroviral Therapy with depression and health related quality of life in patients infected with HIV in Kasempa, Zambia

Abstract

Many HIV-infected patients are accessing antiretroviral therapy (ART) in Zambia. This has enabled them to live longer. However, it is necessary to determine whether such improvements are accompanied with parallel improvements in quality of life. The purpose of this research was to determine whether ART was associated with lower levels of depression and higher levels of health-related quality of life (HRQOL). The primary objective was to compare the association of ART with depression and Health Related Quality of Life (HRQOL) in treatment naïve and treatment experienced patients. The specific objectives were to screen for levels of depression and HRQOL in HIV infected patients, and to compare these levels between ART-experienced and ART-naïve patients. This was a cross sectional study in which 140 HIV-infected adults (70 ART-experienced and 70 ART-naïve) in Kasempa district were enrolled by convenient sampling. Independent variables of sex, age, marital status, education and employment status were matched across the two groups to avoid their confounding effect and bias. Depression and HRQOL were screened using the Centre for Epidemiologic Studies – Depression (CES-D) and Medical Outcomes Survey – HIV (MOS-HIV) tools respectively in both groups. The average scores for depression in both groups were compared using the t-test. Mental Health Summary scores (MHS) and Physical Health Summary scores (PHS) derived from the MOS-HIV tool were obtained by factor analysis and linearly transformed into a 0-100 scale. These scores were also compared between the two groups using the t-test. Multiple linear regression was used to determine the factors that were significantly associated with depression and HRQOL in both groups. The mean depression scores were found to be lower among ART-experienced clients compared with their ART-naïve counterparts with a mean difference of 7.40 (95% C.I 3.77-11.03; P < 0.0001). Overall, ART-experienced participants had higher HRQOL scores compared with their ART- naïve counterparts with differences of 23.0 (95% C.I 16.0-30.1; P < 0.0001) and 11.2 (95% C.I 6.0-16.4; P < 0.0001) in MHS and PHS scores respectively. Being ART-experienced was associated with lower depression scores and higher HRQOL scores when compared with being ART-naïve. Lower depression scores and higher HRQOL scores were associated with being male, married, single, asymptomatic and having higher CD4 counts.