NEW POSITIVE PERSPECTIVES DATA CONFIRM IMPORTANCE OF A HOLISTIC APPROACH TO CARE AND HEALTH-RELATED QUALITY OF LIFE FOR PLHIV

Thanks to rapid advances and innovation in antiretroviral (ARV) treatment, people living with HIV (PLHIV) can live longer, healthy lives with their viral load both undetectable and untransmittable.1 However, with longer life, comes the likelihood of ‘polypharmacy’ (commonly defined as taking five or more pills a day) where multiple medications are needed to manage other long-term health conditions.

Taking multiple medications shouldn’t compromise health-related quality of life, but with 82% (1,731/2,112)2 of PLHIV taking at least one non-HIV pill daily and over 66% (1,393/2,112)2 worried about the long-term effects of HIV medicines, health-related quality of life can be affected - not only related to physical health, but also emotional wellbeing. Data from the Positive Perspectives study (Wave 2), confirm that while taking medication is an inevitable part of living well with HIV, as PLHIV age and develop a range of comorbidities, a comprehensive and holistic approach is needed to evaluate the relationship between polypharmacy and overall health-related quality of life.

The new Positive Perspectives study is one of the largest, global, HIV patient-reported outcomes (PROs) studies to date, with 2,112 PLHIV participating from 24 countries. Building on the unique knowledge and insights gained from the initial Positive Perspectives survey undertaken in 2017, this study was created to generate insights into the remaining unmet needs of PLHIV with respect to treatment management, including the impact of the disease on their quality of life and the importance of holistic care. The first set of published data from the new study looks at polypharmacy (people taking multiple treatments for multiple comorbidities) and its impact on quality of life for PLHIV. 

“In the new Positive Perspectives study, polypharmacy was strongly associated with poorer health-related quality of life, independent of the number of existing co-morbidities. However, neither HIV nor HIV medications should hold a person back from maximising life to its full wonderful potential. We need to encourage people living with HIV to aspire to treatments that not only keep the virus undetectable and minimise side effects, but also support overall wellbeing and quality of life, making HIV a smaller part of their lives.”

- Benjamin Young, Head, Global Medical Directors at ViiV Healthcare 

How does polypharmacy impact quality of life for PLHIV?

While keeping the HIV virus undetectable is of paramount importance, PLHIV with co-morbidities have additional worries about the effects multiple medications can have. Positive Perspectives study results published in the peer-reviewed, public health journal Preventing Chronic Disease reveal that PLHIV who are taking multiple treatments for multiple comorbidities had significantly worse overall health outcomes, including significantly lower prevalence of self-reported virologic control and treatment satisfaction.2 Conversely, optimal overall health was almost 20% higher among those without polypharmacy - 46% (971/2,112) vs 62% (1,309/2,112)2, regardless of viral status, including mental, sexual and physical health outcomes. 

The overall prevalence of polypharmacy was 42% (887/2,112), with more than half (56%, 1,182/2,112) of those in the study concerned about taking more medicines as they plan for living longer lives with HIV.2

Open and active dialogue can make a difference to health outcomes

Empowering PLHIV to be actively involved in their care and treatment decisions throughout their lives is key to helping them achieve good health outcomes and healthrelated quality of life.3,4 Open and active dialogue between healthcare professionals (HCPs) and PLHIV enables PLHIV to feel comfortable discussing their treatment desires and concerns and to play an active role in managing their HIV. 4,5

Published data2 from the new Positive Perspectives study highlight PLHIV are significantly more worried about treatment now than when they started. This underscores the importance of continuously reevaluating the evolving long-term treatment needs of PLHIV based on individual risks of comorbidities, coexisting conditions, concomitant medications and any concerns about treatment.2 By taking a holistic approach when starting or switching ARV therapy, it may be possible for HCPs to provide care that optimises PLHIV wellbeing and contributes to improving health-related quality of life.2

References

  1. Lazarus JV, et al. Beyond viral suppression of HIV – the new quality of life frontier. BMC Medicine 2016;14:94.
  2. Okoli C, de los Rios P, Eremin A, Brough G, Young B, Short D. Relationship Between Polypharmacy and Quality of Life Among People in 24 Countries Living With HIV. Prev Chronic Dis 2020;17:190359. DOI: http://dx.doi.org/10.5888/pcd17.190359
  3. Coutler A, Ellins J. Effectiveness of strategies for informing, educating and involving patients. BMJ 335(7609), 24–27 (2007).
  4. ViiV Healthcare. Data on File – Positive Perspectives Survey 2017.
  5. Chen, W. et al. Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV. Journal of AIDS & Clinical Research 2013, 04(11).