Health-related quality-of-life evaluation in HIV-infected patients. A review of the literature
de Boer, J. B., van Dam, F. S., and Sprangers, M. A.
This article presents a review of the literature on health-related quality-of-life (HRQOL) measurements in HIV-infected patients by means of multidimensional self-report questionnaires. Since 1989, 11 HRQOL instruments have been used, the most frequently employed scales and items being derived from the Medical Outcomes Study. The 9 instruments that were evaluated for their internal consistency reliability and validity generally met the conventional levels of psychometric performance. Descriptive longitudinal and psychometric studies that examined the ability of HRQOL instruments to distinguish between diagnostic groups consistently showed that, over time, patients developed more symptoms and reported poorer physical, role and sexual functioning. Patients' psychological functioning improved or remained at approximately the same level. Despite some methodological limitations, the 4 HRQOL studies performed as part of clinical trials provided valuable information for both patients and doctors about the impact of treatment with zidovudine, interferon-alpha or epoetin (recombinant human erythropoietin) on patients' HRQOL. Future studies are needed that provide more information on the feasibility, stability and responsiveness of existing HRQOL instruments. In addition, future studies should focus on the natural history of HRQOL in HIV-infected patients, and on the impact of commonly prescribed prophylactic and antiretroviral drugs on patients' HRQOL. There is an urgent need for translations and cultural adaptations of HRQOL instruments for use in different HIV-infected populations, including women, children, intravenous drug users and patients from African and other developing countries.