Background
Methods
Study setting and population
Sampling technique
Inclusion criteria
Measurements
Body Composition Assessment
Questionnaire
Quality of Life
Statistical Analysis
Ethical approval
Results
Participant characteristics
Total | ART-naïve | ART | P value | |
---|---|---|---|---|
(n = 903) | (n = 435) | (n = 468) | ||
N (%) | N (%) | N (%) | ||
Age, yrs, median (IQR)
| 33 (29–40) | 32 (28–38) | 35 (30–42) | < 0.0001 |
Female
| 697 (77.2) | 331 (76.1) | 366 (78.2) | 0.450 |
Education
| ||||
No education | 58 (6.4) | 25 (5.8) | 33 (7.1) | 0.654 |
≤ Grade 12 | 820 (90.8) | 399 (91.7) | 421 (90.0) | |
>Grade 12 | 25 (2.8) | 11 (2.5) | 14 (3.0) | |
Housing density (persons/room), median (IQR)
| 2 (1–3) | 2 (1–3) | 1.5 (1–3) | 0.002 |
Employment
| ||||
Full or part time | 250 (27.7) | 115 (26.4) | 135 (28.9) | 0.791 |
Unemployed | 648 (71.8) | 317 (72.9) | 331 (70.3) | |
Other | 5 (0.6) | 3 (0.7) | 2 (0.4) | |
Current smoker
| 136 (15.1) | 75 (17.2) | 61(13.0) | 0.077 |
Ever drank alcohol
| 426 (47.2) | 226 (52.0) | 200 (42.8) | 0.006 |
CD4 count, cells/μl median (IQR)
| 289 (184–455) | 224 (153–437) | 318 (222–468) | <0.0001 |
Previous TB
| 379 (49.8) | 254 (64.0) | 125 (34.3) | < 0.001 |
Treatment regimens
| ||||
d4T 3TC EFV | - | - | 238 (51.8) | |
d4T 3TC NVP | - | - | 169 (36.3) | |
AZT 3TC EFV | - | - | 11 (2.4) | |
AZT 3TC NVP | - | - | 45 (9.6) | |
Other | - | - | 2 (0.4) | |
Duration of treatment (months)
| ||||
d4T | - | - | 13.0 (8.0-20.0) | |
AZT | - | - | 12.0 (7.0-18.5) | |
Body composition
| ||||
BMI, kg/m2, median (IQR) | 25.2 (22.0 -29.6) | 24.2 (21.4-29.0) | 26.0 (22.9-30.0) | 0.0004 |
Waist-to-hip ratio, mean ± SD | 0.85 ± 0.07 | 0.84 ± 0.07 | 0.87 ± 0.08 | < 0.01 |
Sagittal height, cm, median (IQR) | 19.3 (17.0-22.0) | 18.3 (16.5-21.0) | 19.8 (17.5-22.5) | <0.0001 |
Sum of skinfolds, median (IQR) | 108.8 (69.5-158.7) | 103.8 (64.4-164.1) | 111.5 (74.1-153.8) | 0.557 |
Calf skinfolds, median (IQR) | 14.6 (8.4 – 21.6) | 15.6 (9.3-22.6) | 13.4 (7.8-20.5) | 0.012 |
Comparison of Health related quality of Life Outcomes by ART status
Total | ART-naïve | ART | P value | |
---|---|---|---|---|
N (%) | N (%) | N (%) | ||
Mobility
| ||||
No problems | 844 (93.5) | 397 (91.3) | 444 (95.5) | |
Problems | 59 (6.5) | 38 (8.7) | 21 (4.5) | 0.010 |
Self Care
| ||||
No problems | 897 (99.3) | 430 (98.9) | 467 (99.8) | 0.084 |
Problems | 6 (0.7) | 5 (1.2) | 1 (0.2) | |
Usual Activities
| ||||
No problems | 885 (98.2) | 423 (97.5) | 462 (98.7) | 0.167 |
Problems | 17 (1.9) | 11 (2.5) | 6 (1.3) | |
Pain/Discomfort
| ||||
No problems | 680 (75.3) | 316 (72.6) | 364 (77.8) | 0.074 |
Problems | 223 (24.7) | 119 (27.3) | 104 (22.2) | |
Depression/Anxiety
| ||||
No problems | 782 (86.6) | 372 (85.5) | 410 (87.6) | 0.357 |
Problems | 121 (13.4) | 63 (14.5) | 58 (12.4) | |
VAS score, median (IQR)
| 80 (70–95) | 80 (70–90) | 90 (80–100) | <0.0001 |
Mobility | Selfcare | Usual activities | Pain/discomfort | Anxiety/depression | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Variable | OR (95% CI) | p-value | OR (95% CI) | p-value | OR (95% CI) | p-value | OR (95% CI) | p-value | OR (95% CI) | p-value |
ART status
| ||||||||||
ART-naïve vs ART | 3.08 (1.63 - 7.89) | 0.007 | 5.21 (0.45 - 60.27) | 0.187 | 2.40 (0.66 - 8.75) | 0.184 | 1.31 (0.88 - 1.95) | 0.184 | 0.88 (0.53 - 1.89) | 0.607 |
CD4 count, cells/μL
| ||||||||||
> 200 vs ≤ 200 | 1.16 (0.55 - 2.47) | 0.697 | 2.93 (0.28- 30.40) | 0.367 | 0.75 (0.24 - 2.37) | 0.622 | 0.81 (0.54 - 1.21) | 0.311 | 1.14 (0.66 - 1.95) | 0.646 |
Age
| 1.02 (0.99 - 1.06) | 0.242 | 0.92 (0.80 - 1.06) | 0.236 | 0.95 (0.89 - 1.03) | 0.208 | 1.01 (0.99 - 1.03) | 0.471 | 1.01 (0.99 - 1.04) | 0.320 |
Gender
| ||||||||||
Female vs male | 0.44 (0.19 - 1.00) | 0.050 | 1.90 (0.12 -30.97) | 0.651 | 2.04 (0.39 - 10.77) | 0.401 | 0.83 (0.52 - 1.31) | 0.416 | 1.03 (0.55 - 1.91) | 0.933 |
Education
| ||||||||||
No education | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||
≤ Grade 12 | 0.37 (0.13 - 1.06) | 0.065 | 0.028(0.002-0.309) | 0.004 | 0.11 (0.02 - 0.58) | 0.009 | 0.90 (0.41 - 1.94) | 0.779 | 0.59 (0.23 - 1.51) | 0.273 |
>Grade 12 | 0.41 (0.04 - 4.20) | 0.450 | - | - | 0.31 (0.02 - 4.33) | 0.382 | 1.14 (0.31 - 4.29) | 0.841 | 0.59 (0.10 - 3.52) | 0.565 |
Employment
| ||||||||||
Unemployed | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
Full or part time or other | 0.71 [0.31 - 1.59] | 0.400 | 0.75 (0.06 - 9.54) | 0.826 | 0.31 (0.02 - 4.33) | 0.458 | 1.34 (0.90 - 2.00) | 0.150 | 0.59 (0.34 - 1.04) | 0.067 |
Previous TB
| 1.54 (0.72 - 3.28) | 0.267 | 2.23 (0.25 - 19.54) | 0.469 | 3.10 (0.85 - 11.24) | 0.086 | 1.12 (0.75 - 1.66) | 0.583 | 0.51 (0.30 - 0.86) | 0.012 |
BMI category
| ||||||||||
Not obese | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
Obese | 2.78 (1.24- 6.22) | 0.013 | 0.92 (0.07- 11.63) | 0.947 | 1.09 (0.27 - 4.41) | 0.906 | 1.20 (0.77 -1.86) | 0.427 | 1.27 (0.74 - 2.17) | 0.384 |
Variable | Coefficient | 95% CI | p-value |
---|---|---|---|
ART status
| |||
ART vs ART-naïve | 5.61 | 2.50 - 8.72 | <0.001 |
CD4 count, cells/μL
| |||
>200 vs ≤200 | 0.58 | −2.63 - 3.79 | 0.724 |
Age
| −0.034 | −0.20 - 0.13 | 0.682 |
Gender
| |||
Female vs male | 0.66 | −2.95 - 4.26 | 0.720 |
Education
| |||
No education | 1.00 | 1.00 | |
≤ Grade 12 | 0.21 | −6.07 - 6.48 | 0.949 |
>Grade 12 | −5.12 | −15.33 - 5.09 | 0.325 |
Employment
| |||
Unemployed | 1.00 | 1.00 | |
Full or part time or other | 4.76 | 1.63-7.89 | 0.003 |
Housing density
| |||
<1.9 | 1.00 | 1.00 | |
≥ 2 | 1.76 | −1.15 - 4.66 | 0.236 |
Previous TB
| −2.09 | −5.20 - 1.01 | 0.186 |
BMI category
| |||
Not obese | 1.00 | 1.00 | |
Obese | 3.10 | −0.38 - 6.57 | 0.081 |
Comparison of Health related quality of Life Outcomes by ART status according to CD4 count strata
Total | ART-naïve | ART | P value | |
---|---|---|---|---|
N (%) | N (%) | N (%) | ||
Mobility (CD4 count, cells/μL)
| ||||
≤200 | 16 (6.9) | 14 (8.6) | 2 (2.9) | 0.113 |
201-350 | 13 (5.4) | 6 (6.0) | 7 (5.0) | 0.736 |
351-500 | 6 (3.9) | 3 (4.7) | 3 (3.3) | 0.649 |
>500 | 16 (10.3) | 10 (13.2) | 6 (7.5) | 0.244 |
Self care
| ||||
≤200 | 1 (0.4) | 1(0.61) | 0 (0.0) | 0.511 |
201-350 | 1 (0.4) | 1 (1.0) | 0 (0.0) | 0.236 |
351-500 | 1 (0.6) | 0 (0.0) | 1 (1.1) | 0.403 |
>500 | 3 (1.9) | 3 (4.0) | 0 (0.0) | 0.073 |
Usual activities
| ||||
≤200 | 6 (2.6) | 6 (3.7) | 0 (0.0) | 0.104 |
201-350 | 4 (1.7) | 2 (2.0) | 2 (1,4) | 0.733 |
351-500 | 2 (1.3) | 0 (0.0) | 2 (2.0) | 0.235 |
>500 | 4 (2.6) | 3 (4.0) | 1 (1.3) | 0.281 |
Pain/discomfort
| ||||
≤200 | 68 (29.2) | 50 (30.7) | 18 (25.7) | 0.445 |
201-350 | 53 (22.1) | 27 (27.0) | 26 (18.6) | 0.121 |
351-500 | 34 (21.8) | 12 (18.8) | 22 (23.9) | 0.442 |
>500 | 42 (26.9) | 22 (29.0) | 20 (25.0) | 0.578 |
Depression/anxiety
| ||||
≤200 | 32 (13.7) | 22 (13.5) | 10 (14.3) | 0.873 |
201-350 | 33 (13.8) | 10 (10.0) | 23 (16.4) | 0.154 |
351-500 | 18 (11.5) | 7 (10.9) | 11 (12.0) | 0.845 |
>500 | 24 (15.4) | 17 (22.4) | 7 (8.8) | 0.018 |
VAS score, median (IQR)
| ||||
≤200 | 80 (70–90) | 80 (60–90) | 90 (80–100) | 0.0003 |
201-350 | 90 (70–95) | 80 (70–90) | 90 (80–100) | 0.0004 |
351-500 | 90 (80–100) | 82.5 (80–100) | 90 (77.5-100) | 0.455 |
>500 | 80 (70–90) | 80 (70–90) | 90 (80–100) | 0.004 |