HEALTH-RELATED QUALITY-OF-LIFE EVALUATION IN HIV-INFECTED PATIENTS - A REVIEW OF THE LITERATURE

This article presents a review of the literature on health-related qua lity-of-life (HRQOL) measurement in HIV-infected patients by means of multidimensional self-report questionnaires. Since 1989, 11 HRQOL inst ruments 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. De scriptive longitudinal and psychometric studies that examined the abil ity of HRQOL instruments to distinguish between diagnostic groups cons istently showed that, over time, patients developed more symptoms and reported poorer physical, role and sexual functioning. Patients' psych ological functioning improved or remained at approximately the same le vel. Despite some methodological limitations, the 4 HRQOL studies perf ormed as part of clinical trials provided valuable information for bot h patients and doctors about the impact of treatment with zidovudine, interferon-alpha or epoetin (recombinant human erythropoietin) on pati ents' HRQOL. Future studies are needed that provide more information o n the feasibility, stability and responsiveness of existing HRQOL inst ruments. In addition, future studies should focus on the natural histo ry of HRQOL in HIV-infected patients, and on the impact of commonly pr escribed prophylactic and antiretroviral drugs on patients' HRQOL. The re is an urgent need for translations and cultural adaptations of HRQO L instruments for use in differ ent HIV-infected populations, includin g women, children, intravenous drug users and patients from African an d other developing countries.