PEDIATRICS Vol. 117 No. 2 February 2006, pp. 273-283 (doi:10.1542/10.1542/peds.2005-0323)
Quality of Life for Children and Adolescents: Impact of HIV Infection and Antiretroviral Treatment
a Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
b Division of Infectious Diseases, Children's Hospital Boston, Boston, Massachusetts
c Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts
d Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
e Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
BACKGROUND. HIV/AIDS mortality rates in the United States are declining; pediatric HIV has become a chronic disease, with quality of life (QoL) outcomes assuming greater importance.
OBJECTIVES. To compare QoL among HIV-infected and uninfected children and to assess the impact of different antiretroviral regimens on QoL among HIV-infected children.
METHODS. Perinatally exposed, HIV-infected (N = 1847) and uninfected (N = 712) children and adolescents were studied. Among infected children, 1283 were available for the antiretroviral regimen analysis. QoL domain scores were assessed for subjects 6 months to 4 years, 5 to 11 years, and 12 to 21 years of age, and the impact of infection status and alternative treatment regimens on QoL domains was evaluated.
RESULTS. HIV infection was associated with significantly worse mean adjusted scores for functional status among children 6 months to 4 years of age and health perceptions, physical resilience, physical functioning, and social/role functioning among those 5 to 11 years of age. However, uninfected children 5 to 11 years of age reported significantly worse psychological functioning. HIV-infected children (5–11 years of age) and adolescents (12–21 years of age) receiving no antiretroviral treatment had worse health perceptions. Adolescents receiving no antiretroviral agents also had worse symptoms. When antiretroviral regimens were compared, adolescents receiving protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-containing therapy had worse symptoms, compared with those receiving protease inhibitor-containing therapy; otherwise, no significant differences were found.
CONCLUSIONS. Generally parents of HIV-infected children 6 months to 4 years and 5 to 11 years of age generally reported lower mean QoL scores than did parents of uninfected children, although worse psychological functioning was reported for uninfected children. HIV-infected adolescents not receiving antiretroviral treatment had worse health perceptions and symptoms. We found no consistent QoL differences among children receiving different antiretroviral regimens.
Key Words: HIV • quality of life • antiretroviral therapy
Abbreviations: CDC—Centers for Disease Control and Prevention • NNRTI—nonnucleoside reverse transcriptase inhibitor • NRTI—nucleoside reverse transcriptase inhibitor • PACTG—Pediatric AIDS Clinical Trials Group • PI—protease inhibitor • QoL—quality of life
Accepted Jun 1, 2005.
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