Background: Life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative persons. However, little is known about the health-related quality-of-life (HRQoL) of HIV-positive individuals at different stages of disease and treatment, and how it compares to HIV-negative individuals in resource-constrained settings.
Methods: Data on 38,691 adults aged 18-44 years were gathered between October 2013 and March 2015 in cross-sectional surveys of random samples of the general population in 21 communities in Zambia and South Africa as part of the HPTN 071 (PopART) study. In Zambia 21% and in South Africa 22% were HIV-positive. HRQoL information was gathered with an instrument similar to the EuroQol Group''s EQ-5D-5L that measures health in five domains. Responses were scaled into scores taking values between 0 (representing death) and 1 (representing perfect health). Beta-distributed multivariable models were used to analyse differences in HRQoL scores between HIV-positive and HIV-negative individuals unaware of their status, aware but not in care, in care but not on ART, and on ART for less or more than 5 years, adjusted for treatment status, sociodemographic and lifestyle variables.
Results: 19,637 (99%) of 19,750 participants in Zambia and 18,429 (97%) of 18,941 participants in South Africa had complete EQ-5D-5L information. Multivariable regression models show in both countries individuals on ART for at least 5 years reported similar levels of quality-of-life as those HIV-negative. In Zambia, individuals on ART for less than 5 years had a small reduction in score (-0.006, 95% CI -0.009 to -0.003) compared to HIV-negative individuals. In both countries, a large proportion of the sample (44% in Zambia and 53% in South Africa) were unaware of being HIV-positive, but reported good health, showing no significant difference in HRQoL compared to HIV-negatives.
Conclusions: ART is successful in restoring HRQoL of HIV-positive individuals to that of HIV-negative individuals in this general population sample. Individuals in this study who were unaware of being HIV-positive also report good health-related-quality-of-life. The direct health benefits of early diagnosis and ART in preventing losses in health-related-quality-of-life provide support to international advocacy efforts for scale-up of testing and expansion of treatment to all HIV-positive individuals.

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