Trajectories of health-related quality of life among people with HIV within five years of diagnosis.

BACKGROUND: Evidence on changes in health-related quality of life (HRQoL) beyond the first year after HIV diagnosis remains limited. This study examined both the overall changes and distinct trajectories of HRQoL in people newly diagnosed with HIV over a five-year period. METHODS: Individuals newly diagnosed with HIV were consecutively recruited from the Center for Disease Control and Prevention in Hunan Province, China. Participants completed self-administered questionnaires at the time of diagnosis and at one- and five- year post-diagnosis. HRQoL was assessed using the Medical Outcomes Study HIV Survey. Depression, anxiety, stress, and social support were measured using the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire, the HIV/AIDS Stress Scale, and the Social Support Rating Scale, respectively. Repeated-measures analysis of variance and Bonferroni correction for multiple comparisons was conducted to examine the overall changes in HRQoL. Latent class growth analysis was applied to identify distinct HRQoL trajectory subgroups. Multinomial logistic regression and generalized linear regression analyses were used to examine baseline predictors of unfavorable HRQoL trajectories, as well as the effects of psychosocial status changes on HRQoL levels at five years post-diagnosis. RESULTS: A total of 320 participants who completed all three-time point surveys were included. Overall, significant improvements in HRQoL, including physical health summary (PHS) and mental health summary (MHS) scores, were observed over five years. Trajectory analyses identified three PHS subgroups, including "medium-worsening (3.6%)", "low-improving (13.0%)", "high-stable (83.4%)"; and four subgroups for MHS trajectory, including "worsening-improving (15.0%)", "low-improving-stable (15.0%)", "high-stable (63.1%)", "stable-worsening (6.9%)". Participants with lower education levels were more likely to experience declines in MHS, whereas those presenting with clinical symptoms at baseline were more likely to experience deteriorations in PHS over the subsequent five years. Moreover, individuals experiencing worsening depressive symptoms, persistent severe anxiety, elevated stress, or early declines in social support were more likely to have lower HRQoL at five years post-diagnosis. CONCLUSIONS: Although HRQoL generally improved over the five years following HIV diagnosis, a small but notable proportion of individuals experienced unfavorable HRQoL trajectories. Monitoring and addressing time-varying psychosocial factors is essential to optimize long-term HRQoL outcomes in people with HIV.