Radical reductions in health inequalities with HIV treatment
New research shows antiretroviral treatment radically reduces health inequalities – supporting arguments for scale-up of HIV treatment in low-resourced settings.
A large-scale study in South Africa and Zambia reveals that people living with HIV and on treatment for more than five years have no significant difference in their health-related quality of life compared to HIV-negative people.
Antiretroviral treatment (ART) has long been shown to add years to patients’ lives, such that people living with HIV can now expect to live just as long as HIV-negative people. Yet there’s been little research into the effect of ART on a patients' quality of life, which can provide vital insight for policymakers on the benefits of HIV interventions.
The study, published in The Lancet, determined patients' health-related quality of life based on mobility and ability to do daily activities, and their experiences of pain, anxiety and depression.
Participants were at different stages of HIV care and grouped into six categories: HIV-negative; HIV-positive and unaware of their status; aware of their HIV positive status but not accessing care; HIV positive and in care but not taking ART; HIV positive and accessing ART either for more than five years or less than five years.
Remarkably, the study found that people who had adhered to treatment for over five years had no significant difference in their quality of life compared to HIV-negative people. This result highlights the efficacy of ART, not only in extending life but in improving the quality too. The results stood even after controlling for variations in age, gender, education, religion, ethnicity, presence of herpes simplex 2 virus and use of recreational drugs.
However, the study stresses the importance of adherence, as these positive results only applied to those receiving ART for over five years. Individuals who were aware of their HIV-positive status but had not started HIV care or treatment reported the most problems and lowest quality of life.
Interestingly those who had HIV but were unaware of their status, did not report any significant differences in their health-related quality of life compared to HIV-negative individuals either. This could be indicative of them being in the early stages of infection or else hint at the damaging effects of stigma on the quality of life of those with HIV.
This study provides the first insight into health-related quality of life in HIV-positive individuals since the scale-up of ART in lower income countries. The results of this study support the World Health Organization's ‘Treat all’ guidelines, recommending that anyone with an HIV positive diagnosis should be eligible for ART, as the treatment was shown to have significant effects on patients even in the very earliest stages of the disease.
The researchers comment that they hope this study reminds policy makers that medicine should ‘add years to life, and life to years’. Furthermore, these findings make clear that an HIV diagnosis no longer has to stop you from leading a long and happy life.
The study is part of the ongoing PopART trial (HPTN 071), a large-scale community-based trial evaluating the effects of universal HIV testing and treatment on HIV incidence.