Re Esp Quimio e 2025; 38(4)
h p://www.doi.o g/10.37201/ eq/032.2025
www. e espquimio e apia.com
O iginal a icle
Fac o s Associa ed wi h Adequa e Quali y o Li e Le els in HIV
Pa ien s Du ing a Fi e-Yea Longi udinal S udy
Fac o es asociados con ni eles adecuados de calidad de ida en pacien es
con VIH du an e un es udio longi udinal de cinco años
En ique Con e as-Macías1* , Ramón Mo illo-Ve dugo2
1Hospi al San Juan De Dios, Se illa, España
2Hospi al Uni e si a io Vi gen de Valme, Se illa, España
Recei ed: Ma ch 7, 2025
Accep ed: Ap il 1, 2025
Published: Ap il 16, 2025
*Co espondence: En ique Con e as-Macías. [email p o ec ed]
Abs ac
In oduc ion: Ad ances in an i e o i al he apy (ARV) ha e imp o ed he li e expec ancy o people li ing wi h HIV (PLWH), shi ing
he ocus o quali y o li e (QoL). Howe e , aging, polypha macy, and como bidi ies pose challenges. This s udy aimed o e alua e
he e olu ion o QoL o e i e yea s and iden i y associa ed sociodemog aphic, clinical, and pha maco he apeu ic ac o s.
Me hods: A single-cen e e ospec i e obse a ional s udy was conduc ed in PLWH a ending a e ia y hospi al ou pa ien
pha macy. QoL was assessed using he EQ-5D-5L ques ionnai e. Sociodemog aphic, clinical, and pha maco he apeu ic
a iables—including age, polypha macy, como bidi ies, and Medica ion Regimen Complexi y Index (MRCI)—we e analyzed.
Mul i a ia e logis ic eg ession iden i ied p edic o s o good QoL, de ined as a Visual Analogue Scale (VAS) sco e ≥76.
Resul s: A o al o 437 PLWH we e included wi h median age 52 yea s. The pa icipan s we e majo i y male (82.8%). Th oughou
he s udy, mean VAS sco es emained s able, wi h 63.7–73.4% o pa icipan s epo ing good QoL each yea . The mos equen ly
epo ed issues we e ela ed o mobili y (8.9%), pain/discom o (5.1%), and anxie y/dep ession (3.0%). Mul i a ia e analysis
showed ha ad anced age (OR: 1.55, 95%CI: 1.14–2.11), polypha macy (OR: 1.87, 95%CI: 1.35–2.59), como bidi ies (OR: 2.13,
95%CI: 1.76–2.89), and socioeconomic p oblems (OR: 2.47, 95%CI: 1.44–4.21) we e signi ican ly associa ed wi h lowe QoL.
Conclusion: Aging, polypha macy, and socioeconomic dispa i ies signi ican ly impac QoL in PLWH. In eg a ing QoL assess-
men s in o ou ine ca e and add essing hese ac o s h ough comp ehensi e managemen s a egies could enhance long-
e m well-being.
Keywo ds: HIV. Highly ac i e an i e o i al he apy (HAART). Heal h- ela ed quali y o li e. Heal h ou comes. Pha maceu ical ca e.
Resumen
In oducción: Los a ances en la e apia an i e o i al (TAR) han mejo ado la espe anza de ida de las pe sonas que i en con VIH
(PVVIH), asladando el en oque a la calidad de ida (QoL). Sin emba go, el en ejecimien o, la poli a macia y las como bilidades p e-
sen an desa íos. Es e es udio e aluó la e olución de la QoL du an e cinco años e iden i icó ac o es sociodemog á icos, clínicos y
a maco e apéu icos asociados.
© 2025 The Au ho (s). This a icle is dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional (CC BY-NC 4.0) (h ps://c ea i ecom
mons.o g/licenses/by-nc/4.0/). Published by on behal o he Sociedad Española de Quimio e apia.
E. Con e as, e al. Fac o s Associa ed wi h Adequa e Quali y o Li e Le els in HIV Pa ien s Du ing a Fi e-Yea Longi udinal S udy
Mé odos: Se ealizó un es udio obse acional e ospec i o en PVVIH a endidos en la a macia ambula o ia de un hospi al e cia io.
La QoL se e aluó con el cues iona io EQ-5D-5L y se analiza on a iables como edad, poli a macia, como bilidades e Índice de Com-
plejidad del Régimen de Medicación (MRCI). Se u ilizó eg esión logís ica mul i a ian e pa a iden i ica p edic o es de buena QoL,
de inida como una pun uación en la Escala Visual Analógica (VAS) ≥76.
Resul ados: Se incluye on 437 PVVIH (mediana de edad: 52 años; 82,8% homb es). La pun uación media de la VAS se man u o
es able, con un 63,7–73,4% de pa icipan es epo ando buena QoL. Los p incipales p oblemas epo ados ue on mo ilidad (8,9%),
dolo /males a (5,1%) y ansiedad/dep esión (3,0%). La edad a anzada (OR: 1,55), la poli a macia (OR: 1,87), las como bilidades (OR:
2,13) y los p oblemas socioeconómicos (OR: 2,47) se asocia on con meno QoL.
Conclusión: La QoL en PVVIH se e a ec ada po el en ejecimien o, la poli a macia y las desigualdades socioeconómicas. E alua-
ciones u ina ias y es a egias in eg ales pueden mejo a el bienes a a la go plazo.
Palab as cla e: VIH. Te apia an i e o i al de g an ac i idad (TARGA). Calidad de ida elacionada con la salud. Resul ados en salud.
A ención a macéu ica.
In oduc ion
The op imiza ion in he immuno i ological con ol o
HIV in ec ion, hanks o he imp o emen o an i e-
o i al ea men (ARV), has esul ed in people li ing
wi h HIV (PLWH) expe iencing enhanced su i al,
achie ing a li e expec ancy nea ly equi alen o he se-
onega i e popula ion [1]. All his has led o a shi in
he p o ile o HIV pa ien s, and we a e acing an aging
HIV coho , wi h pa ien s de eloping age- ela ed co-
mo bidi ies esul ing in polypha macy and ail y [2].
The p og essi e aging o his popula ion p esen s us
wi h a se ies o challenges ha will con inue o in-
c ease, as i is es ima ed ha by 2030, 73% o PLWH
in Eu ope will be o e 50 yea s old [2]. All o his
aises he isk o polypha macy, he isk o ad e se
e en s due o educed unc ional ese e, ch onic in-
lamma ion, and immune sys em de e io a ion, wi h
nega i e consequences o he quali y o li e (QoL)
o PLWH [3].
The high a e o polypha macy among he popula-
ion wi h HIV in ec ion, coupled wi h he p esence o
complica ed dosing schedules o special ins uc ions
such as die a y in e ac ions, may con ibu e o inc ea-
sed di icul y o pa ien in e es in adhe ing p ope ly
o ea men [4]. In his con ex , a ious ools ha e
been de eloped o assess he complexi y o pha -
maco he apy. These ools ep esen he ini ial s ep
owa ds achie ing a be e quan i a i e and quali a i-
e unde s anding o how he complexi y o p esc ibed
medica ions impac s adhe ence, medical ou comes,
and QoL [5]. The e is al eady a s udy ha ound he
nega i e in luence o pha maco he apeu ic comple-
xi y on he quali y o li e pe cei ed by pa ien s using
he EQ-5D-5L scale [6]. The assessmen o changes
in QoL om he pa ien ’s pe spec i e be o e and a e
heal hca e in e en ions can be acili a ed h ough
he u iliza ion o ins umen s such as he EQ-5D. This
s anda dized ques ionnai e o e s a s aigh o wa d,
gene ic measu e o heal h o bo h clinical e alua ion
and economic assessmen pu poses [7].
The e alua ion o QoL has ga ne ed signi ican accep-
ance wi hin he ealm o HIV pa ien ca e, wi h he
Wo ld Heal h O ganiza ion (WHO) endo sing i as a
pi o al ou come in clinical p ac ice. This endo semen
led o i s inco po a ion as a ou h a ge wi hin he
“90-90-90” goals es ablished by he WHO in 2016 [8].
In he 2021 ‘Consensus s a emen on he ole o heal h
sys ems in ad ancing he long- e m well-being o peo-
ple li ing wi h HIV’, a global panel o HIV expe s empha-
sized he impo ance o sel - epo ed Heal h-Rela ed
Quali y o Li e (HRQoL) as a undamen al ou come in
bo h indi idual pa ien ca e and he b oade moni o ing
o heal h sys em esponses o HIV a na ional and glo-
bal le els [9].
Poo e HRQoL ou comes p edic ed ad e se ou comes
o HIV pa ien s, such as hospi aliza ions o any cau-
se and mo ali y [7,10]. The e o e, achie ing op imal
HRQoL ou comes o PLWH, who expe ience a g ea e
bu den o mul imo bidi y han he gene al popula ion,
can con e signi ican bene i s [11]. The aim o his
s udy was o analyze he e olu ion o QoL among he
HIV popula ion o e a 5-yea pe iod o de e mine he
in luence o ela ed sociodemog aphic, clinical and
pha maco he apeu ic ac o s in good QoL.
Ma e ial and me hods
S udy design and pa icipan s
This single-cen e e ospec i e obse a ional s udy
was conduc ed a a e ia y hospi al. PLWH a ending
he hospi al’s ou pa ien pha macy se ice be ween
Janua y 2020 and Decembe 2024 we e included.
Rou ine clinical p ac ice a he hospi al includes he
assessmen o QoL o all PLWH using alida ed ins-
umen s du ing hei isi s. Fo his s udy, only ho-
se pa ien s wi h comple e QoL da a spanning he ull
i e-yea pe iod we e included in he analysis.
Va iables we e collec ed du ing ou pa ien hospi al
pha macy isi s w ARV, bo h he i s and subse-
quen discon inua ions. The ollowing a iables we e
Re Esp Quimio e 2025; 38(4)
analyzed: demog aphic (age, sex); clinical a iables
ela ed o analy ical da a (plasma i al load, CD4 cell
coun ), como bidi ies and pha maco he apeu ics,
such as s a i ica ion le el, ype o ARV (bo h be o e
and a e discon inua ion), p esence o polypha -
macy and majo polypha macy, p esence o como -
bidi ies and medica ion egimen complexi y index
(MRCI). Only pa ien s wi h all comple ed a iables
we e included in he analysis.
De ini ion o he endpoin
The ou come was de ined as heal h- ela ed quali y o
li e, measu ed wi h he Spanish e sion o he EQ-5D-
5L ques ionnai e, a alida ed ool o assessing QoL in
ch onic pa ien s. This ins umen e alua es i e heal h
dimensions (mobili y, sel -ca e, usual ac i i ies, pain/
discom o , and anxie y/dep ession) using i e le els
o se e i y. Responses we e g ouped in o h ee ca e-
go ies (no p oblems, mild-mode a e p oblems, se e e-
ex eme p oblems) o acili a e analysis.
Addi ionally, a Visual Analogue Scale (VAS) om
0 o 100 was used o cap u e pa ien s pe cei ed o e-
all heal h, wi h sco es ≥76 conside ed indica i e o
good QoL [12]. Due o he lack o a speci ic alue
se o Spain du ing he s udy pe iod, he Eu oQol-
ecommended c osswalk me hodology was applied
o de i e 5L alues om 3L da a [13].
De ini ions
The h eshold o 50 yea s was used o iden i y elde -
ly pa ien s acco ding o he upda ed e sion o he
“Consensus Documen o Elde ly HIV Pa ien s” [14].
Unde ec able i al load was de ined as a alue o less
han 50 copies/mL, in acco dance wi h he analy ical
me hod employed a he hospi al.
Como bidi y was de ined as any ch onic disease ha
was p esen in he pa ien a he beginning o ha
appea ed du ing he s udy. Toge he wi h he p esen-
ce o absence o como bidi y, and he ype o como -
bidi y was eco ded. Como bidi y pa e ns we e also
classi ied acco ding o he s udy published by De
F ancesco e al [15].
ARV egimens we e sys ema ically ca ego ized ac-
co ding o hei pha macological classes as ollows:
a combina ion o wo nucleoside e e se ansc ip a-
se inhibi o s (NRTIs) in conjunc ion wi h a hi d agen ,
which could be ei he a non-nucleoside e e se ans-
c ip ase inhibi o (NNRTI), a p o ease inhibi o (PI),
o an in eg ase s and ans e inhibi o (INSTI). ARV
egimens ha de ia e om he con en ional iple-
he apy amewo k desc ibed abo e, inco po a ing
al e na i e he apeu ic s a egies, we e classi ied
unde he b oade ca ego y o “o he egimens.” Fu -
he mo e, ARV egimens we e also s a i ied by he
numbe o an i e o i al agen s included in he ea -
men scheme, dis inguishing be ween iple he apy,
dual he apy, and mono he apy app oaches.
Polypha macy was de ined as he use o 6 o mo e di-
e en d ugs, including an i e o i al medica ion; ma-
jo polypha macy was de ined as he use o 11 o mo e
d ugs. To desc ibe he pa e ns o polypha macy, we
employed he ca ego iza ion p oposed by Calde ón-
La añaga e al. who classi ied he pa e ns depending
on he ype o disease hey we e in ended o ea :
ca dio ascula , dep ession-anxie y, acu e espi a o y
in ec ion, ch onic pulmona y disease, hini is-as hma,
pain and menopause [16]. A pa ien was classi ied in a
speci ic pa e n o polypha macy when he pa ien was
p esc ibed a leas h ee d ugs included in ha pa e n.
The MRCI is a alida ed 65-i em ool ha e alua es
ea men egimen complexi y based on he numbe
o medica ions, dosage o m, dosage equency, and
addi ional o special ins uc ions. This index sco e
anges om 1.5 ( o someone aking a single able o
capsule aken once a day) o an unde ined maximum
since he sco e inc eases wi h he numbe o medica-
ions; g ea e sco es indica e highe complexi y [17].
Addi ionally, acco ding o Mo illo-Ve dugo e al. a cu -
o alue o 11.25 o MRCI index sco e was employed
o conside ing a pa ien as complex [18].
S a is ical analysis
Disc e e a iables we e exp essed as coun s (pe -
cen ages), and con inuous a iables as medians wi h
in e qua ile anges (IQRs) o means and s anda d
de ia ions (SD). Di e ences in ca ego ical a iables
we e calcula ed using a wo-sided likelihood a io
chi-squa e es o Fishe ’s exac es , and he s uden
- es o Mann-Whi ney U es we e used o con i-
nuous a iables, when app op ia e. No mali y was
assessed using he by Kolmogo o -Smi no o Shapi o-
Wilk es s, depending on g oup size.
To de e mine he p edic i e ac o s o good QoL, a
mul i a ia e logis ic eg ession model was cons uc-
ed, including hose a iables ha showed di e en-
ces in he uni a ia e analysis. The model’s i was
assessed using he Hosme -Lemeshow goodness-
o - i es , and i s disc imina o y abili y was e alua ed
by he a ea unde he cu e (AUC-ROC).
The h eshold o s a is ical signi icance was de ined
as p<0.05. The s a is ical analysis was conduc ed
using SPSS S a is ics o macOS, e sion 28.0, and all
es s we e wo- ailed.
E. Con e as, e al. Fac o s Associa ed wi h Adequa e Quali y o Li e Le els in HIV Pa ien s Du ing a Fi e-Yea Longi udinal S udy
E hics
Da a collec ed om he s udy coho is gene a ed du-
ing usual ca e. The s udy ul illed all he e hical equi-
emen s and was app o ed by he Clinical Resea ch
E hics Commi ee o Se illa-Su (C.I. 1340-N-23). This
s udy was ca ied ou in acco dance wi h he Decla-
a ion o Helsinki guidelines o biomedical esea ch.
Resul s
O he 637 PLWH, 437 pa icipan s comple ed he
ques ionnai e o e he i e-yea pe iod and we e in-
cluded in his s udy. A baseline, he median age was
52 yea s (IQR: 43-58 yea s), and 82.8% we e male. Ba-
seline cha ac e is ics a e shown in Table 1.
Th oughou he i e yea s analyzed, he mean sco e
on he VAS QoL scale consis en ly indica es a good
quali y o li e. No signi ican di e ences we e ound
when analyzing he p- alue o linea end (p=0.84).
Th oughou he analyzed pe iod, mos PLWH included
did no epo issues in he domains assessed by he
EQ-5D ques ionnai e. Table 2 showed he p og ession
o his sco e o e he yea s and EQ-5D answe s.
A bi a ia e analysis was conduc ed o iden i y so-
ciodemog aphic and pha maco he apeu ic a iables
in g oups o pa icipan s wi h a VAS sco e o 76 o
highe and hose wi h a VAS sco e <76. Table 3 p e-
sen s he comple e esul s o he analysis.
The mul i a ia e model de eloped showed signi ican
di e ences o pa ien s wi h a VAS sco e <76 in e-
la ion o ad anced age, polypha macy, p esence o
como bidi ies and socioeconomic p oblems. The ull
desc ip ion o he model is p esen ed in Table 4. The
Table 1. Baseline cha ac e is ics o people li ing wi h HIV a ending he ou pa ien pha macy om 2020 o 2024.
Baseline cha ac e is ics PLWH (N=437)
Males; n (%) 362 (82.8)
Age; median (Q1-Q3) 52 (43-58)
≥ 50 yea s; n (%) 269 (61.6)
S a i ica ion le el*
N1 22 (5)
N2 23 (5.3)
N3 392 (89.7)
CD4 coun ≥200 cells/mm3; n (%) 425 (97.4)
Unde ec able i al load (<50 copies/mL); n (%) 421 (96.5)
AIDS s age; n (%) 105 (24)
Mon hs on ARV ac i e; median (Q1-Q3) 180 (130-192)
P esence o como bidi y; n (%) 217 (49.7)
Como bidi y pa e ns
Ca dio ascula disease 143 (68.4)
Psychia ic neu ological pa hology 47 (22.5)
Li e - COPD disease 15 (7.2)
Gene al heal h pa hology 4 (1.9)
Polypha macy; n (%) 113 (25.9)
Majo Polypha macy; n (%) 51 (11.7)
MRCI ≥11.25; n (%) 63 (14.4)
ARV Regimen
2 NRTIs + NNRTI 108 (24.8)
2 NRTIs + PI/b 75 (17.2)
2 NRTIs + INSTI 168 (38.4)
Re Esp Quimio e 2025; 38(4)
Table 2. E olu ion o quali y-o -li e sco es and EQ-5D ques ionnai e esponses in people li ing wi h HIV du ing he
2020–2024 pe iod.
Yea 2020 2021 2022 2023 2024
Socioeconomic p oblems 25 (5.7) 49 (11.2) 29 (6.6) 43 (9.8) 36 (8.2)
Nu i ional p oblems 8 (1.8) 11 (2.5) 9 (2.1) 15 (3.4) 17 (3.9)
Mean VAS Sco e (SD) 76 (20) 77 (21) 82 (18) 79 (22) 76 (23)
PLWH wi h VAS sco e ≥ 76; n (%) 252 (57.7) 260 (59.4) 321 (73.4) 312 (71.5) 278 (63.7)
Response EQ-5D domains
Mobili y, I ha e no p oblems in walking abou 434 (99.3) 437 (100) 434 (99.3) 424(97) 398 (91.1)
Sel -ca e, I ha e no p oblem wi h sel -ca e 425 (97.3) 437 (100) 434 (99.3) 430 (98.4) 424(97)
Usual ac i i ies, I ha e no p oblem wi h pe o ming
my usual ac i i ies 435 (99.5) 436 (99.8) 434 (99.3) 427 (97.7) 398 (91.1)
Pain/Discom o , I ha e no pain o discom o 414 (94.7) 399 (91.4) 424(97) 419 (95.9) 415 (94.9)
Anxie y/Dep ession, I am no anxious o
dep essed 404 (92.4) 406 (93) 424(97) 381 (87.2) 424(97)
VAS: Visual Analogic scale.
...con inua ion able 1.
ARV Scheme
T iple he apy 378 (86.5)
Dual The apy 32 (7.3)
Mono he apy 27 (6.2)
AIDS: acqui ed immune de iciency synd ome; ARV: an i e o i al he apy; COPD: ch onic obs uc i e pulmona y disease; NRTI: nucleo-
side e e se ansc ip ase inhibi o ; NNRTI: non-nucleoside e e se ansc ip ase inhibi o s; PI/b: p o ease inhibi o boos ed; INSTI:
in eg ase s and ans e inhibi o .
*Le els N1, N2, and N3 a e de i ed om he pha maceu ical ca e s a i ica ion model desc ibed in he SEFH-MAPEX guidelines, wi h
N1 ep esen ing pa ien s equi ing he mos in ensi e pha maceu ical ca e and N3 hose wi h he leas need o such in e en ions.
Table 3. Bi a ia e analysis o sociodemog aphic, clinical, and pha maco he apeu ic ac o s associa ed wi h quali y o li e
in people li ing wi h HIV.
VAS sco e ≥ 76 (n=321) VAS sco e < 76 (n=116) P- alue
Male; n (%) 270 (84.1) 99 (85.3) 0.87
Age; median (IQR) 53 (44-58) 54 (50 – 59) 0.21
≥ 50 yea s; n (%) 182 (56.7) 81 (69.8) 0.02
S a i ica ion le el; n (%)*
N1 11 (3.4) 9 (7.7) 0.09
N2 9 (2.8) 11 (9.5) <0.01
N3 300 (93.5) 97 (83.6) <0.01
Socioeconomics p oblems; n (%) 14 (4.3) 18 (15.5) <0.01
Nu i ional p oblems; n (%) 4 (1.2) 6 (5.2) 0.04
CD4 coun ≥200 cells/mm3; n (%) 306 (95.3) 106 (91.4) 0.18
E. Con e as, e al. Fac o s Associa ed wi h Adequa e Quali y o Li e Le els in HIV Pa ien s Du ing a Fi e-Yea Longi udinal S udy
...con inua ion able 3.
Unde ec able i al load (<50 copies/mL); n (%) 278 (86.6) 96 (82.8) 0.39
AIDS s age; n (%) 76 (23.7) 29 (25) 0.87
Mon hs on ARV ac i e; median (Q1-Q3) 178 (126-189) 183 (137-204) 0.88
P esence o como bidi y; n (%) 124 (38.6) 93 (80.2) <0.01
Como bidi y pa e ns
Ca dio ascula disease 79 (63.7) 64 (68.8) 0.52
Psychia ic neu ological pa hology 26 (21) 21 (22.6) <0.01
Li e - COPD disease 11 (8.9) 4 (4.3) 0.08
Gene al heal h pa hology 1 (0.8) 3 (3.2) 0.13
Polypha macy; n (%) 68 (21.2) 46 (39.7) <0.01
Majo Polypha macy; n (%) 31 (9.7) 20 (17.2) 0.03
MRCI ≥11.25; n (%) 43 (13.5) 20 (17.2) 0.39
ARV Regimen
2 NRTIs + NNRTI 74 (23.1) 32 (27.6) 0.4
2 NRTIs + PI/p 55 (17.1) 20 (17.2) 0.89
2 NRTIs + INSTI 121 (37.7) 45 (38.8) 0.92
O he s 71 (22.1) 19 (16.4) 0.24
ARV Scheme
T iple he apy 276 (86) 102 (88) 0.71
Dual he apy 26 (8.1) 7 (6) 0.61
Mono he apy 19 (5.9) 7 (6) 0.93
AIDS: acqui ed immune de iciency synd ome; ARV: an i e o i al he apy; COPD: ch onic obs uc i e pulmona y disease; NRTI: nu-
cleoside e e se ansc ip ase inhibi o ; NNRTI: non-nucleoside e e se ansc ip ase inhibi o s; PI/b: p o ease inhibi o boos ed;
INSTI: in eg ase s and ans e inhibi o .
*Le els N1, N2, and N3 a e de i ed om he pha maceu ical ca e s a i ica ion model desc ibed in he SEFH-MAPEX guidelines, wi h
N1 ep esen ing pa ien s equi ing he mos in ensi e pha maceu ical ca e and N3 hose wi h he leas need o such in e en ions.
Table 4. Resul s o mul i a ia e logis ic eg ession.
Odds Ra io 95%CI p- alue
≥ 50 yea s 1.55 1.14 – 2.11 <0.01
S a i ica ion le el
N2 1.25 0.41 – 3.75 0.69
N3 0.76 0.36 – 1.58 0.46
P esence o como bidi ies 2.13 1.76 – 2.89 <0.01
Psychia ic neu ological pa hology 0.83 0.43 – 1.61 0.58
Polypha macy 1.87 1.35 – 2.59 <0.01
Majo Polypha macy 1.12 0.76 -1.96 0.12
Socioeconomics p oblems 2.47 1.44 – 4.21 <0.01
Nu i ional p oblems 1.94 0.26 – 3.97 0.78
Re Esp Quimio e 2025; 38(4)
Figu e 1. Recei e ope a ing cha ac e is ic cu e o logis ic eg ession model.
Hosme -Lemeshow es alue was p=0.1 which sug-
ges s ha he logis ic eg ession model used has a
good i o he da a. The ROC cu e was cons uc ed,
and his showed ha he model includes a iables
ha p edic QoL in PLWH (a ea unde cu e = 0.81
[95%CI, 0.78-0.83) (Figu e 1).
Discussion
Ou s udy demons a es ha ad anced age, polypha -
macy, and socioeconomic p oblems a e ac o s ha
in luence he a ainmen o good QoL in PLWH. Ad-
di ionally, acco ding o ou esul s, mo e han hal o
he pa ien s ollowed h oughou he analyzed pe iod
exhibi ed a good QoL.
The impo ance o achie ing and main aining a good
QoL in PLWH s ems om he 90-90-90 a ge s. In
2021, UNAIDS in oduced a new s a egy i led “End
Inequali ies: End AIDS, Global AIDS S a egy 2021-
2026,” which aised he a ge s o 95% [19]. Howe e ,
his upda ed s a egy did no speci ically include a
a ge ela ed o he QoL in PLWH. This may indica-
e a shi owa ds in eg a ing quali y o li e assess-
men s in o he ou ine ca e and moni o ing o hese
pa ien s [20,21]. Some coun ies, such as Aus alia,
ha e included speci ic QoL a ge s in hei na ional
HIV s a egies o 2018-2022, de ining ha “75% o
PLWH epo a good QoL” [22]. The da a indica e ha
mo e han hal o he included popula ion main ains
a good QoL, wi h a sligh inc easing end in he pe -
cen age o PLWH.
P e ious s udies ha e desc ibed a co ela ion be-
ween lowe QoL and age in PLWH, pa icula ly hose
aged 50 yea s and olde [23,24]. Fo ins ance, a s udy
conduc ed in a public hospi al wi hin he heal hca e
ne wo k o he Communi y o Mad id obse ed ha
olde PLWH unde going ea men exhibi ed lowe
QoL, especially in physical aspec s and le els o in-
dependence [25]. Consis en wi h hese indings, he
esul s o ou s udy also indica e ha olde PLWH ex-
pe ience a educ ion in QoL compa ed o younge age
g oups.
The p esence o non-AIDS-de ining como bidi ies in
PWLH has been ecognized as a c i ical ac o nega-
i ely impac ing QoL, pa icula ly among aging indi-
iduals. Ch onic condi ions such as ca dio ascula
disease, diabe es, and neu opsychia ic diso de s
con ibu e o physical limi a ions, polypha macy,
and inc eased heal hca e u iliza ion. Fu he mo e,
HIV-associa ed neu ocogni i e diso de s exace ba e
unc ional impai men and psychological dis ess,
E. Con e as, e al. Fac o s Associa ed wi h Adequa e Quali y o Li e Le els in HIV Pa ien s Du ing a Fi e-Yea Longi udinal S udy
u he comp omising QoL. These indings unde -
sco e he necessi y o a comp ehensi e, mul idis-
ciplina y app oach o HIV ca e ha p io i izes ea ly
de ec ion and in eg a ed managemen o como bid
condi ions [26,27].
Polypha macy is ecognized as a isk ac o o ne-
ga i e heal h ou comes ela ed o ea men , such
as d ug in e ac ions o subop imal adhe ence. Many
PLWH exp ess conce ns abou he side e ec s o
bo h ARV and concomi an medica ions, which
a ec s hei quali y o li e. As a esul , hey end o
epo lowe quali y o li e sco es compa ed o pa-
ien s who a e no on polypha macy [25]. Howe e ,
when compa ing pa ien s wi h majo polypha macy,
no signi ican di e ences in QoL a e obse ed, which
may be a ibu ed o he ela i ely low pe cen age o
pa ien s expe iencing majo polypha macy. Ano he
s udy indica es ha PLWH epo be e QoL compa-
ed o se onega i e pa ien s wi h ch onic condi ions,
such as ype 1 diabe es and heuma oid a h i is. This
di e ence may be a ibu ed o he pha maco he a-
peu ic complexi y, as ARV o en in ol es simpli ied e-
gimens, including single- able egimens, in con as
o ea men egimens ha equi e pa en e al o mu-
la ions [28]. Wi hin he con ex o PLWH, i has been
obse ed ha high pha maco he apeu ic complexi y
is associa ed wi h lowe pa ien -pe cei ed QoL [6].
On he o he hand, ad ances in ARV ha e signi ican ly
inc eased he su i al o PLWH due o op imal immu-
no i ological con ol. As a esul , HIV in ec ion can
now be ega ded as a ch onic disease. Al hough no
clea associa ion was ound be ween he du a ion o
ARV and quali y o li e, ecen s udies sugges ha
s abili y in ARV access and adhe ence may play a key
ole in he well-being o PLWH. Howe e , PLWH ace
unique de e minan s o QoL compa ed o hose wi h
o he ch onic diseases, such as ype 1 diabe es o
heuma oid a h i is. While ad ancemen s in an i e-
o i al he apies ha e simpli ied ea men egimens,
enhancing adhe ence and imp o ing ce ain aspec s
o QoL, he pe asi e impac o social s igma emains
signi ican . This s igma, encompassing biases ela-
ed o diagnosis and con iden iali y, deeply a ec s
he psychological and social well-being o pa ien s,
in ways no di ec ly pa alleled in mos o he ch onic
condi ions. In con as , ch onic condi ions like diabe-
es o en lack his p o ound psychological and social
impac bu may pose mo e di ec physical challen-
ges. These indings unde sco e he necessi y o com-
p ehensi e s a egies ha add ess bo h clinical and
social aspec s o HIV ca e. [29,30].
Based on he esul s p esen ed, se e al u u e e-
sea ch a enues could be explo ed, such as expanding
he esea ch o mul iple hospi al cen e s o enhance
he gene alizabili y o he indings and ex ending he
obse a ion pe iod beyond i e yea s o cap u e long-
e m changes in QoL. I is impo an o no e ha olde
pa ien s may ha e been li ing wi h HIV o a longe pe-
iod, which could con ound he ela ionship be ween
age and QoL. The du a ion o in ec ion may in luence
bo h clinical ou comes and QoL, gi en he cumula i e
e ec s o ch onic in ec ion, ea men exposu e, and
como bidi ies. Fu u e analyses should conside inclu-
ding his a iable in he eg ession model i such da a
a e a ailable, as i could p o ide a mo e nuanced un-
de s anding o he p edic o s o QoL in PLWH. Mo eo-
e , he indings iden i y un a o able socioeconomic
condi ions as a isk ac o , sugges ing ha s udies
analyzing he impac o socioeconomic ac o s mo e
deeply could help imp o e QoL, including quali a i e
s udies o be e unde s and pa ien expe iences.
This s udy has se e al limi a ions ha should be ac-
knowledged. I s unicen ic design may limi he ge-
ne alizabili y o indings, al hough he homogenei y
o clinical p o ocols ein o ces in e nal alidi y. The
p edominance o male pa icipan s is consis en wi h
he highe p e alence o HIV diagnoses among men
in Eu ope. The inclusion o only pa ien s wi h comple-
e i e-yea ollow-up da a may ha e led o selec ion
bias; howe e , as exclusions we e mainly due o la e
consul a ion en ollmen , signi ican bias is unlikely.
Addi ionally, while he EQ-5D-5L is a alida ed QoL as-
sessmen ool, i may no ully cap u e HIV-speci ic
conce ns, sugges ing he need o disease-speci ic
measu es and quali a i e app oaches add essing
psychosocial ac o s. The de ini ion o adequa e QoL
using a VAS sco e o 76, al hough suppo ed by he
Eu oQol guidelines, has no been speci ically alida-
ed o PLWH. Fu he mo e, psychosocial and socioe-
conomic p oblems we e eco ded as a global a ia-
ble wi hou de ailed s a i ica ion, limi ing insigh s
in o speci ic de e minan s such as income, employ-
men , o heal hca e access. Gi en hese limi a ions,
u u e mul icen e s udies a e wa an ed o enhance
ex e nal alidi y and deepen he unde s anding o
QoL in PLWH.
In conclusion, he s udy p o ides aluable insigh in o
QoL o PLWH, emphasizing he impo ance o ac o s
such as ad anced age, polypha macy, and socioeco-
nomic issues in achie ing a good QoL. The indings
highligh he need o in eg a e QoL assessmen s in o
ou ine clinical p ac ice o enhance he managemen
and well-being o PLWH. Al hough he unicen ic
na u e o he s udy limi s he gene alizabili y o he
esul s, he longi udinal app oach and he use o a-
lida ed ools such as he EQ-5D p o ide a solid oun-
da ion o u u e esea ch and imp o emen s in he
ca e o his popula ion.
Re Esp Quimio e 2025; 38(4)
Funding
None o decla e.
Con lic s o in e es
The au ho s decla e ha hey ha e no con lic o in-
e es .
Au ho con ibu ions
Concep ualiza ion, E.C.M. and R.M.V.; me hodology,
E.C.M. and R.M.V.; o mal analysis, E.C.M.; w i ing—
o iginal d a p epa a ion: E.C.M. and R.M.V.; w i ing—
e iew and edi ingl au ho s, E.C.M. and R.M.V. All
au ho s ha e ead and ag eed o he published e -
sion o he manusc ip .
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