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Health-related quality of life among people with HIV at low-to-moderate risk for atherosclerotic cardiovascular disease in the REPRIEVE Trial
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Among PWH in the REPRIEVE Mechanistic Substudy with low-to-moderate ASCVD risk, utilizing the SF-36v2 instrument, we found that older age, Black non-Hispanic race, higher BMI, and smoking were associated with worse physical HRQoL. Notably, our analysis showed no strong association between cardiometabolic factors and physical HRQoL in adjusted models. For mental HRQoL, no significant associations were found in this cohort. Moreover, statin use did not have a negative effect on quality of life in the study population. These findings highlight the importance of addressing modifiable risk factors in PWH to sustain, preserve, and enhance quality of life across the lifespan.
As PWH live longer, age-associated comorbidities are increasingly prevalent and may lead to disability and limitations at an earlier age [10], both of which may reduce quality of life. Among these comorbidities is cardiovascular disease (CVD), and it has been predicted that by 2030, 78% of PWH will have CVD [11]. Having metabolic disease, characterized by a cluster of traditional CVD risk factors such as abdominal obesity, impaired glucose, elevated triglyceride levels, reduced high-density lipoprotein levels, and hypertension, is highly associated with increased risk of CVD, which may lead to physical and mental impairment [12,13]. The correlation between HRQoL and cardiometabolic disease is not yet fully elucidated. Few studies to date have evaluated the impact of cardiovascular characteristics on HRQoL among PWH [14,15].
The present study examined self-reported HRQoL and factors associated with physical and mental HRQoL domains in a population of PWH at low-to-moderate risk for atherosclerotic CVD (ASCVD). We further sought to evaluate whether the physical and mental domains of HRQoL were associated with cardiometabolic risk factors and the change in each domain over time by treatment group (pitavastatin vs. placebo), hypothesizing that subclinical atherosclerosis would be associated with worse HRQoL.
Diggs, Marissa R.a; Chu, Sarah M.a; Fitch, Kathleen V.a; Olefsky, Maxineb; Watanabe, Maya G.b; Erlandson, Kristine M.c; Lu, Alex B.a; Bloomfield, Gerald S.d; Currier, Judith S.e; Curran, Adrianf; Eckard, Allison Rossg; Smith, Graham H.R.h; Sponseller, Craig A.i; Fichtenbaum, Carl J.j; Malvestutto, Carlos D.k; Aberg, Judith A.l; Foldyna, Borekm; Taron, Janam,n; Karady, Juliam; Zanni, Markella V.a; Douglas, Pamela S.o; Ribaudo, Heather J.b; Lu, Michael T.m; Grinspoon, Steven K.a
Background:
There is limited evidence concerning the relationship between cardiometabolic characteristics and health-related quality of life (HRQoL), and potential effects of statin therapy among people with HIV (PWH).
Methods:
The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) enrolled PWH aged 40–75 years on antiretroviral therapy (ART) with low-to-moderate ASCVD risk. Coronary computed tomography angiography assessed coronary plaque among a subset of participants in the REPRIEVE Mechanistic Substudy at baseline and 24 months. The Short Form-36-Item Health Survey Version 2 was collected at baseline, and physical (PCS) and mental (MCS) component summary scores were determined. We explored the relationship of PCS and MCS with cardiometabolic characteristics, coronary atherosclerosis, and assessed change in score by treatment group (pitavastatin vs. placebo).
Results:
Of 733 participants, median age was 51 years, 84% were male, 34% were Black non-Hispanic, and median years diagnosed with HIV was 15. At baseline, for participants randomized to pitavastatin vs. placebo the median PCS was 54.5 (Q1, Q3: 46.9, 57.7) vs. 54.1 (47.5, 58.0), and the median MCS was 52.9 (44.1, 57.6) vs. 52.8 (44.0, 57.9). In fully adjusted analyses, older age, Black non-Hispanic race/ethnicity, ART regimen class, elevated BMI, and cigarette smoking were associated with lower PCS. No clear trends were apparent with MCS. Between baseline and month 24, declines in PCS and MCS were minimal with no apparent difference by treatment group.
Conclusions:
Among this cohort of ART-treated PWH, baseline cardiometabolic risk factors were associated with worse self-reported physical HRQoL, with no apparent effect of statin therapy.
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