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Study: Quality of Life Improves After Starting Second-Line HIV Treatment

The point of second-line antiretroviral therapy (ART) is to reduce HIV replication in individuals who no longer respond to first-line treatment. Besides suppressing the virus, second-line ART regimens containing protease inhibitors also significantly improve quality of life, a new study has shown.

The key finding of the study is that self-reported quality of life (QoL) improved significantly for all domains of life – including a 3% improvement in social functioning, 4% in cognitive functioning, 5% in energy, 6% in mental health, and 11% in employment/school functioning – during the year after starting second-line ART. Study findings will be published in the journal AIDS later this year.

“We saw that quality of life improved after second-line therapy initiation with no difference between treatments,” said Thiago Torres, the lead author of the study and HIV researcher at Harvard T. H. Chan School of Public Health. “These results are important to support the use of protease inhibitors in second-line regimens.”

Torres also noted that the World Health Organization recommends protease inhibitors in both of its preferred second-line regimens.

Physicians in San Francisco introduced the idea of measuring QoL in HIV-positive people two decades ago. Their patient surveys began assessing QoL with the simple question, “How have things been going for you?” In recent years, the measurement of QoL has grown to include physical, social, and psychological functioning in addition to subjective well-being.

All 512 participants in the study had experienced virologic failure after an average of 4 years on a non-nucleoside reverse transcriptase inhibitor (NNRTI) –based, first-line regimen. When they began second-line therapy, participants had an average viral load over 30,000 copies/mL – far higher than the threshold for virologic failure. They took four QoL assessments over the course of their first year after starting second-line ART.

Study participants beginning second-line treatment with greater HIV disease severity (e.g. higher viral load and lower CD4 T-cell count) initially had poorer average QoL. Previous research confirms that greater disease severity is correlated with lower QoL. Yet Torres’ study found that QoL improvements were greater in participants who began the study with a poorer disease status, such that these differences disappeared after one year of second-line ART use.

“Thus, ongoing effective ART with successful virologic suppression and immunologic recovery is important to support improvements in QoL,” added Torres, “especially in resource-limited settings, where individuals may start or switch ART after longer periods of detectable viral load than in higher income settings.”

This study was conducted in nine resource-limited countries across Asia, Africa, and South America. Future studies are needed to confirm whether starting second-line therapy is also linked to QoL improvements in middle- and high-income countries like the U.S.