Quality of life among persons living with HIV who receive clinical care at a healthcare institution in Tijuana, Mexico

1. Quality of life in persons living with
HIV in a healthcare institution of
Tijuana, Mexico
Jhonis Quintero1, David Goodman1,
José Burgos1, Fátima Muñoz1, María
Ibarra2, María Zuñiga1, 2
Sixth Annual CFAR International HIV/AIDS Research Day
September 18, 2012
Affiliation: 1 University of California San Diego, 2 ISSSTECALI, Tijuana, Mexico
Funding: AIDS International Training in Research Grant (1D43TW008633‐01)

2. INTRODUCTION
• Health‐related quality of life (HRQoL)
multidimensional concept.
– Physical and social functioning, mental health, pain
and energy (Briongos et al, 2011).
• HIV chronic disease, HRQoL important health
indicator (Valencia et al, 2010).

3. BACKGROUND
• HIV prevalence in Mexico 0.3 %.
– HIV prevalence in Tijuana 3 times the national
average in the general population (Brouwer et al, 2006).
• No previous studies exploring HRQoL among
HIV patients in México.
Studies HRQoL (mean, SD) using MOS‐HIV*
Briongos et al, 2011 (Spain) PHSa 52.3 (8.8)
MHSb 49.3 (9.9)
Perez et al, 2005 (Spain) PHSa 50 (10.6)
MHSb 50 (9.6)
Miners, et al, 2004 (London) PHSa 41.8 (13.2)
MHSb 43.2 (12.2)
*MOS‐HIV: Medical Outcomes Study HIV Health Survey
aPHS: Physical Health Score. bMHS: Mental Health Score

4. OBJECTIVES
• Explore HRQoL in patients receiving HIV care
in a government health care institution in
Tijuana Mexico.
• Determine the association between
sociodemographic and clinical variables with
HRQoL.

5. METHODS
• Cross‐sectional study.
• Target population: HIV infected adult patients
receiving care in a government hospital in
Tijuana, Mexico (ISSSTECALI).
• Recruitment period: Nov 2010 ‐ June 2011.

6. • Medical Services
Institute for B.C.
State workers.
• 4.16 % of state health
beneficiaries.
bajacalifornia.gob.mx. 2009

7. Summary of MOS‐HIV Survey Concepts
Dimensions METHODSExplanation
Physical Functioning Physical activities (eating, dressing, bathing)
• Total 54 patients were selected.
Role Functioning Problems with work or daily activities
• Approaching: consultation with medical doctor.
Pain No‐severe pain
General Health Perceptions instrument: personal health
• Investigation Views Disease‐specific
Medical Outcomes Study HIV social activities
Social Functioning Limitations Health Survey
(MOS‐HIV) instrument (Wu et al).Tired/energetic
Energy
• Sociodemographic Nervous, depressed/calm, peaceful, happy
Mental Health data was collected using a
Health Distress
standardized questionnaire. Despair, discouraged, afraid due health
Cognitive Functioning Concentrating, reasoning, remembering
• Clinical variables were obtained through
electronic record of hospital. could hardly be worse/better
Quality of life Life bad/good,
Adapted from MOS‐HIV Health Survey, Users manual. Wu. 1996‐99

8. MOS‐HIV Dimensions
General
Energy Health Social Fn
Cognitive
Fn
Pain
Physical Health
Fn Mental
distress
Health
Role Fn QoL
Physical Health Mental Health Summary
Summary (PHS) score (MHS) score
Revicki, Sorensen and Wu, 1998

9. ANALYSIS
• Descriptive statistics: Means, standard deviation (SD),
proportions.
• Student‐t test, ANOVA were used to identify
associations between sociodemographic and clinical
variables with PHS and MHS (dependent variables).
• Multivariate linear regression model.
– Variables attaining p<0.20 in univariate analysis were
considered in the final model.
– Backward stepwise linear regression; variables with
significance p<0.05 were retained.
• Data were analyzed using SPSS v20.0 (IBM).

10. ENROLLMENT 62 eligible
participants
3 decline to
participate
5 could not be found
54 participants were
included in the
analysis

11. Clinical characteristics
Sociodemographic characteristics N (%) N (%)
Characteristic drug use
History injection 5 (9.2)
Years since HIV Diagnosis (mean, SD)
Gender (male) 45 (83.3) 6.5 (4.5)
Years on antirretroviral tratment (ART) (mean, SD)
Age (mean, SD) 44.0 (9.4) 4.9 (4.0)
All Comorbilities 29 (53.9)
Marital status
ART regimen
Single 29 (53.7)
First line (Mexico*) 45 (83.3)
Married 19 (35.2)
Not first line 8 (14.8)
Common law relationship 4 (7.4)
No treatment 1 (1.9)
Widowed 2 (3.7)
T CD4+ Lymphocyte count (mean, SD) 720.5 (599.4)
Sexual orientation
<200 cells/μm3 2 (3.7)
Heterosexual 30 (55.6)
200‐499 cells/μm3 18 (33.3)
Homosexual 20 (37.0)
>500 cells/μm3 34 (63.0)
Bisexual
Viral load, log (mean, SD) 4 (7.4) 2.0 (0.9)
Education
Viral load, categories
Primary school
<40 copies/ml 19 (35.2) 39 (72.2)
High school
41‐1000 copies/ml 13 (24.1) 8 (14.8)
*CENSIDA Guideline 2012 University
>1000 copies/ml 22 (40.7) 7 (13.0)

12. Mean Scores for the MOS‐HIV
Domains Mean Median SD
Physical Health Summary Score 56.6 57.2 5.7
Mental Health Summary Score 56.9 58.2 13.1
Dimensions
Pain 88.3 100 19.4
Physical Functioning 87.2 90 13.5
Role Functioning 89.3 100 20.1
General Health Perceptions 78.7 80 17.4
Social Functioning 92.4 100 19.9
Energy 77.0 80 15.1
Mental Health 77.6 80 16.5
Health Distress 82.2 80 18.3
Cognitive Functioning 80.0 80 19.6
Quality of Life 84.1 80 14.7

13. Univariate Analysis for Sociodemographic Variables
Category N PHS p MHS p valor
(%) (Mean, SD) valor (Mean , SD)
Gender
Female 9 59.1 (3.0) .15 55.7 (5.1) .65
Male 45 56.1 (6.09 57.1 (8.7)
Age
18‐44 y 30 56.0 (6.5) .39 57.0 (9.1) .90
> 45 y 24 57.3 (4.49 56.7 (7.3)
Marital status
Single 29 55.6 (6.9) .55 54.9 (5.6) .04
Married 19 58.0 (4.2) 59.4 (5.6)
Widowed 2 55.9 (1.1) 48.8 (4.7)
Common law relationship 4 57.3 (0.8) 63.7 (2.7)
Sexual orientation
Heterosexual 30 57.9 (3.7) <.001 58.1 (5.8) <.001
Homosexual 20 56.7 (5.0) 58.0 (7.2)
Bisexual 4 46.2 (10.9) 41.7 (14.6)

14. Univariate Analysis for Clinical Variables
Category N PHS p MHS p
(%) (Mean, SD) valor (Mean, SD) valor
ART regimen
First line (Mexico) 45 56.6 (5.7) .61 56.0 (1.3) .22
Not first line 8 57.3 (5.9) 61.5 (6.0)
No treatment 1 51.2 58.8
Comorbilities
Yes 29 55.4 (6.7) .11 54.7 (9.7) .03
No 25 57.9 (3.8) 59.4 (5.3)
T CD4+ Lymphocyte count
<200 cells/μm3 2 45.0 (16.6) <.01 43.1 (29.8) .04
200‐499 cells/μm3 18 56.5 (4.9) 56.3 (5.9)
>500 cells/μm3 34 57.3 (7.3) 58.0 (7.2)
Viral load
<40 copies/ml 39 57.6 (4.5) .10 54.1 (9.1) .14
40‐1000 copies/ml 8 54.1 (9.1) 51.7 (13.5)
>1000 copies/ml 4 53.8 (5.9) 56.5 (6.8)

15. Final multivariate linear regression models
Linear regression for Physical Health summary score
Variable B SE IC95% P
Sexual orientation a ‐4.2 1.0 ‐6.3, ‐2.0 <.001
Years since diagnosis 0.4 0.2 0.1, 0.7 .01
Viral load (log) ‐2.6 0.7 ‐4.1, ‐1.1 .001
Intercept 65.5 2.1 61.3, 69.7
Linear Regression for Mental Health summary score
Variable B SE IC95% P
Sexual orientation a ‐5.3 1.5 ‐8.4, ‐2.2 .001
ART regimen b 3.6 1.3 1.0, 6.2 .007
T CD4+ Lymphocytesc 4.4 1.7 0.9, 7.8 .014
Intercept 45.9 6.0 33.9, 57.9
aSexualorientation: Heterosexual (reference), homosexual, bisexual
BART regimen: First line (reference), not first line according to Mexican guidelines
CT CD4+ Lymphocytes: <200 (reference), 200‐499, >500

16. LIMITATIONS
• Small sample size.
• Not representative to all HIV infected
population in Tijuana, B.C. Mexico.
– High socioeconomics status.
• Social desirability bias.
• Cross sectional.
– Temporal association cannot be ascertained.

17. CONCLUSIONS
• Our study shows that the summary scores were
higher than those reported from other countries
(Briongos et al, 2011. Perez et al, 2005. Miners, et al, 2004).
• Sexual orientation, still affecting HRQoL, may be
related with stigma.
• Years since diagnosis, increases HRQoL, probably
because late start ART.
• ART regimen affects HRQoL, related with newest ART.
• Positive relation between TCD4+ and HRQoL.
• Negative tendency between viral load and HRQoL.

18. IMPLICATIONS
• HRQoL must be considered multidimensional,
to modify and improve health in these
patients.
• HRQoL monitoring should be incorporated in
standard HIV care in Mexico.
• Prospective studies are needed to better
understand factors related to HRQoL.

19. ACKNOWLEDGEMENT
• Dr. Goodman, Dr. Burgos, Dr. Muñoz, Dr.
Ibarra, Dr. Zuñiga, Dr. Strathdee.
• AIDS International Training and Research
Program (AITRP).
• Hospital ISSSTECALI, Tijuana.
• Center for AIDS Research (CFAR).