The effect of cytomegalovirus retinitis on the quality of life of patients with AIDS in the era of highly active antiretroviral therapy

Abstract

Purpose: To evaluate the effect of cytomegalovirus (CMV) retinitis on quality of life (QOL) in patients with the acquired immune deficiency syndrome (AIDS).

Design: Enrollment data from a multicenter, prospective cohort study.

Participants: Patients >/=13 years of age with AIDS in three groups: no CMV retinitis, 709 patients; long-standing CMV retinitis (diagnosed a median of 34.5 months previously), 212 patients; and newly diagnosed CMV retinitis (diagnosed </=45 days previously), 50 patients.

Methods: Patients were enrolled at 19 centers throughout the United States. CMV retinitis status was determined by ophthalmoscopy. Vision-related QOL was assessed with a questionnaire designed for patients with CMV retinitis. General health-related QOL was evaluated with a modified version of the Medical Outcomes Survey-HIV instrument. Health utility was measured with the EuroQol instrument.

Main outcome measures: Patient-reported vision-related QOL, general health-related QOL, and health utility.

Results: All domains of vision-related QOL were substantially lower in both the long-standing and newly diagnosed CMV retinitis groups than in the group with no CMV retinitis. The long-standing CMV retinitis group was similar to the no CMV retinitis group in most general health-related QOL domains and in health utility measures. The newly diagnosed CMV retinitis group scored substantially worse than the other groups in many of the general health-related QOL domains and in visual analog scale-measured health utility. Adjustment of selected scale scores for demographic characteristics and for CD4(+) T-cell count, human immunodeficiency virus viral load, and use of highly active antiretroviral therapy (HAART) attenuated most of the differences in general health-related QOL, except that physical function scores remained significantly lower in the newly diagnosed CMV retinitis group. Adjustment did not alter the pattern of vision-related QOL results.

Conclusions: These results suggest that in the HAART era, CMV retinitis is associated with reduced vision-related QOL in patients both with newly diagnosed and with long-standing disease, even though patients with long-standing CMV retinitis seem to have general health-related QOL and health utility similar to that of patients with AIDS who do not have CMV retinitis. Newly diagnosed CMV retinitis also is associated with lower general health-related QOL in most domains and with lower health utility.