|Year : 2012 | Volume
| Issue : 4 | Page : 263-267
Quality of life in HIV/AIDS patients in relation to CD4 count: A cross-sectional study in Mysore district
Sudhir Gowda1, Ashok Nagaralu Channabasappa1, Murali Dhar2, Deepa Krishna3
1 Department of Community Medicine, JSS Medical College Mysore, India
2 Department of Statistics, Manipal University Level 6, Health Sciences Library Building, Manipal, India
3 Department of Biochemistry, JSS Medical College Mysore, India
|Date of Web Publication||27-Feb-2013|
Department of Community Medicine, JSS Medical College, JSS University, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
Background: With the recent advances in clinical tests and treatments for those suffering from HIV/AIDS, the survival of these patients has been increased and their quality of life has become an important focus for researchers and healthcare providers. HIV affects the CD4 cells and CD4 count is the basis on which the ART treatment is started. Objective: To study the relationship of CD4 count with Quality of life of HIV/AIDS patients. Materials and Methods: This cross-sectional study was done in 255 HIV/AIDS patients at ART center in tertiary care hospital, Mysore. WHO-QOL-BREF a summarized quality of life questionnaire was used to assess the Quality of life. CD4 count of each patient was done. Statistical analysis was done using Epi-info software. To test the significance between QoL score and CD4 count, a t test was applied and to see the correlation between QoL score and various domains, Pearson's correlation co-efficient was calculated. Results: Out of 255 patients, 149 patients had their CD4 count below 350 with a mean QOL score 50.6 and 106 patients had their CD4 count above 350 with a mean QOL score 55.2. A positive correlation was seen with a r value of 0.31. Patients with higher CD4 count had better QOL than those with lower CD4 counts; the t test showed statistically significant association ( P < 0.05) between CD4 count and QOL. Conclusion: Present study has revealed a strong relationship between QOL and CD4 count of HIV/AIDS patients which necessitates pragmatic interventions to improve the CD4 count.
Keywords: Antiretroviral treatment, human immunodeficiency virus/AIDS, quality of life and CD4 count
|How to cite this article:|
Gowda S, Channabasappa AN, Dhar M, Krishna D. Quality of life in HIV/AIDS patients in relation to CD4 count: A cross-sectional study in Mysore district. Int J Health Allied Sci 2012;1:263-7
|How to cite this URL:|
Gowda S, Channabasappa AN, Dhar M, Krishna D. Quality of life in HIV/AIDS patients in relation to CD4 count: A cross-sectional study in Mysore district. Int J Health Allied Sci [serial online] 2012 [cited 2021 Sep 27];1:263-7. Available from: https://www.ijhas.in/text.asp?2012/1/4/263/107892
| Introduction|| |
Human immunodeficiency virus (HIV), one of the worst pandemics, in today's world has a devastating physical and psychological effect. Due to early detection and availability of antiretroviral treatment (ART), HIV has become a chronic disease rather than a fatal illness. Consequently, quality of life is an important component in the evaluation of patients well-being following HIV infection.
Quality of life is a term that is popularly used to convey an overall sense of well-being and includes aspects such as happiness and satisfaction with life as a whole. World health organization has defined QOL as "individual's perceptions of their position in life in context of the culture and value systems in which they live and in relation to their goals, standards, expectations, and concerns".  With the recent advances in clinical tests and treatments for those suffering from HIV/AIDS, the survival of these patients has been increased and their QOL has become an important focus for researchers and health care providers. 
The main cells of HIV attacks are the T-helper cell or CD4+ cell. The T-helper cell has a protein CD4+ on its surface. HIV needs the CD4+ in order to enter the cells it targets to infect. If HIV is able to enter the T-helper cell, it can take over the cell and then use it to duplicate itself. When HIV produces more copies of itself, the number of CD4+ cells decreases. The pathogenesis of HIV infection is largely attributed to the decrease in the number of T cells that bear the CD4 receptor. 
The immune status of a patient living with HIV can be assessed by measuring the absolute number (per mm 3 ) or percentage of CD4+ cells, and this is regarded as the standard way to assess and characterize the severity of HIV-related immunodeficiency. Progressive depletion of CD4+ T cells is associated with progression of HIV disease and a higher likelihood of opportunistic infections and other clinical events associated with HIV, including wasting and death. 
Normal absolute CD4 count in adolescents and adults ranges from 500 to 1500 cells per mm 3 of blood. In general, the CD4 cell count (% CD4 or absolute count) progressively decreases as HIV disease advances. The CD4 count usually increases in response to effective combination antiretroviral therapy (ART) although this may take many months. Measurement of CD4 is used to assess and monitor response to ART. The CD4 test measures the number of CD4 or T-helper cells in the blood. The estimation of the CD4 count for patients receiving ART is recommended at 6 months to document immunological improvement. 
The main objective of this study was to find the relation of CD4 count with Quality of life in HIV/AIDS patients.
| Materials and Methods|| |
This study was a cross-sectional study which was done between June 2011 and December 2011 among HIV/AIDS patients aged more than 18 years on anti-retroviral therapy, with no severe psychiatric or cognitive problems. Ethical committee clearance was taken from institution time-bound research committee and informed consent from the patients.
For the estimation of sample size, the mean and standard deviation of quality of life as reported by Nojami et al.  was used. In order to estimate QOL with allowable error of 1 at 99% confidence interval, the required sample size was estimated to be minimum of 252.
The formula used for calculating sample size is as follows:
The population under study was HIV/AIDS patients of Mysore district who were expected to be registered at ART center of tertiary care hospital. A list of all the patients registered at ART center was obtained. Utilizing this list as a sampling frame, a simple random sampling was done. In total, 255 HIV/AIDS patients were interviewed from ART center tertiary care Hospital, Mysore. For estimating Quality of life, instrument used was a summarized quality of life questionnaire of World Health Organization (WHO-QOL-Brief) that included 26 questions; 24 questions covered the four main domains such as physical health, psychological health, social functions, and environmental domain. Two questions included the satisfaction of overall health.
The items under the domains were
Dependence of treatment, energy and fatigue, mobility, presence of pain and discomfort, sleep and rest, activities of daily living and perceived working capacity.
Affect, positive self concept, negative feelings, higher cognitive functions, body image, and spirituality.
Social contacts, family support, sexual activity.
Freedom, quality of home environment, physical safety and security, involvement in recreational activity, quality of health and social care and accessibility to services.
Each answer to the question was measured on the Likert scale of 1-5, later each domain score was calculated which had a set of questions, and the domain score was converted to a scale of 0-20, with a minimum possible score of domain was given score 0 and maximum possible score of domain was given score 20, and by multiplying this score with 5, final score in the range of 0-100 was calculated for each domain, and the mean of all the domain score together gave the quality of life score in the range of 0-100.
And for each patient interviewed, the CD4 count was done by the ELISA method at ART Center. The CD4 count cut off was taken as 350 because ART is started to HIV patients with CD4 count less than 350 according to NACO guidelines.
The data entry and the statistical analysis were performed by using Microsoft Excel and Epi-info software version 3.5.3, respectively. To test the significance between QOL and CD4 count, the t test was applied at 5% level of significance and to see the correlation between QoL score and various domains Pearson's co-efficient was estimated. In addition, regression analysis was done to study the role of various domains in QoL. We fitted regression equation of form Y = a + bX for univariate analysis and of the form Y = a + b 1 X 1 + b 2 X 2 + b 3 X 3 + b 4 X 4 for multiple regression analysis, where Y is the dependent variable that is QoL score and X 1 , X 2 , X 3 and X 4 were the independent variables that's the four domains.
| Results|| |
In the study, a total of 255 patients were included, sex distribution was almost equal, most of patients were married, illiterate, and belonged to lower socioeconomic status by modified Kuppuswamy classification. The sociodemographic profile of the study subjects is shown in [Table 1].
The comparison between QoL score and CD4 count is shown in [Table 2]. Patients with CD4 count more than 350 had better QoL score than patients with CD4 count less than 350. The mean QoL score for patients with CD4 count < 350 was 50.6 and for patients with CD4 count > 350 was 55.2, the difference being statistically significant P < 0.05. A positive correlation was seen between QoL and CD4 count with value of correlation coefficient to be 0.31 and this is shown in [Figure 1], this correlation was statistically significant with P < 0.05.
There was significant positive correlation between CD4 cell count and all the four domains of WHO QoL. With social domain showing highest positive correlation with CD4 count and least was seen with physical domain [Table 3].
|Table 3: Correlation between the CD4 cell count and quality of life domains|
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It was seen that there was significant difference in mean domain scores with respect to CD4 count in all the domains except in social domain [Table 4].
In [Table 5], the dependent variable was QoL score and independent variables were the domains. When univariate regression coefficient is calculated for each domains against QoL, it is seen that psychological well-being has got more effect on QoL, but when multiple linear regression coefficient is calculated it is found that social relation has got more effect on QoL.
|Table 5: Results summary of univariate and multiple linear regression analysis of QoL as dependent variable and the domains as independent variable|
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| Discussion|| |
In our study, the environmental domain had a maximum mean score. This suggests that the patients had relatively better quality of health services and good accessibility, whereas the domain hardly hit was the social domains with score less than the other domains indicating that the patients social contacts and sexual activity were affected markedly.
We have found significant association between QoL and CD4 count; patients with higher CD4 count had better quality of life than patients with lower CD4 count. In an assessment of the Quality of life in HIV/AIDS patients attending the ART clinic at a tertiary hospital in South India it was found that QOL scores were significantly lower among persons with lower CD4 count.  Assessment of Quality of life of people living with HIV/AIDS in Sao Paulo, Brazil, Subjects with CD4 cell counts below 200 cells/mm 3 had lower QOL scores.  Health-Related Quality of Life (HR-QOL) in 154 individuals infected with HIV in London hospital recorded reduced levels of HR-QOL compared with the general population. Lower CD4 counts were associated with lower HR-QOL scores.  Evaluation of the reliability and validity of the two generic instruments, the WHOQOL and the SF-36 (Short Form Health Survey), for assessing health-related quality of life was conducted by Ping-Chuan Hsiung et al., in 224 patients with HIV infection in Taiwan. They concluded that patients with higher CD4 cell counts and with less intensity of symptoms scored significantly higher on both instruments. 
It has been seen that higher CD4 count is seen with better nutrition, education, higher socioeconomic status, and employment. , The ultimate goal for treatment is not only to promote longevity but also to enhance the QoL. Strategies developed to foster communication with a good health care support system may result in potentially higher QoL outcomes. So every effort should be made to increase the CD4 count of HIV patients.
Lack of economic assistance and treatment availability in rural areas is a challenge in improving quality of life of HIV-infected people. Lack of knowledge and education among the patients is also one of the major obstacles in improving their quality of life.
| Conclusion|| |
Quality of life of HIV-infected people is significantly determined by the CD4 count and an advanced stage of HIV infection needs more attention and care with respect to physical, psychological, environment, and social aspect of life. This information can be utilized in planning a broad range of services including primary medical care, financial assistance, housing, food, child care, and educating the patients how to remain healthy.
| Limitations|| |
Due to the cross-sectional design, the findings point more toward an association rather than cause and effect. Various psychological symptoms are associated with HIV infection and associated with quality of life; factor is not taking into account in the present study. Future studies should attempt to show the impact of cognitive functioning on quality of life of HIV-infected people.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]