Beyond viral suppression: determinants of health-related quality of life in a national HIV cohort in Turkiye

Abstract

This multicentre study evaluated Health-related Quality of Life (HRQoL) and identified sociodemographic and clinical determinants of physical and mental health outcomes in a large national HIV cohort in Turkiye. This cross-sectional study included 1303 adults across 23 centres. HRQoL was assessed using the Turkish MOS-HIV Health Survey, yielding Physical Health Summary (PHSS) and Mental Health Summary (MHSS) scores. HRQoL scores were dichotomised into "higher" (>50) and "lower" (≤50) groups. Data were analysed via univariate tests and multivariable logistic regression. Participants (88.6% male; median age: 38) were primarily single, employed, and university graduates. The median CD4+ T-cell count and HIV RNA level were 627 cells/mm3 and <50 copy/mL, respectively. Median PHSS and MHSS were 57.25 and 50.57, respectively. While social/role functioning scored highest, health transition scored lowest. Lower PHSS was identified in 22.7% of participants, whereas 47.9% reported lower MHSS. Low education and high daily pill burden significantly increased the risk of lower HRQoL. Interestingly, lower income was independently associated with better HRQoL, while older age and psychiatric treatment correlated with better MHSS. Despite robust physical HRQoL, mental health remains a significant challenge. To achieve "Fourth 90" targets, interventions should prioritise health literacy and integrated mental health services within HIV care.​​Abbreviations: ART: antiretroviral therapy; CF: cognitive functioning; CI: confidence interval; EF: energy/fatigue; GH: general health perception; HAART: highly active antiretroviral therapy; HD: health distress; HIV: human immunodeficiency virus; HL: Hosmer-Lemeshow; HRQoL: health-related quality of life; HT: health transition; MHS: mental health summary; MHSS: mental health summary score; MOS-HIV: medical outcomes study HIV health survey; OR: odds ratio; P: pain; PF: physical functioning; PHS: physical health summary; PHSS: physical health summary score; PLWH: people living with HIV; QL: quality of life; RF: role function; RNA: ribonucleic acid; SF: social function; UNAIDS: joint United Nations programme on HIV/AIDS.