Associations Between Long COVID Symptoms and Health-related Quality of Life among a Medicaid Managed Care Population Living with HIV
Main Article Content
Abstract
Background: Lasting symptoms following an infection of acute COVID-19, known as post-acute sequelae of SARS-CoV-2 infection (PASC), negatively impact health-related quality of life in the general population. Although people living with HIV (PLWH) face a higher disease burden compared to people without HIV, there is limited research on how PASC is associated with health-related quality of life among people living with HIV.
Methods: This study recruited 107 people living with HIV with a documented diagnosis of COVID-19 from a Medicaid-managed care plan, yielding 105 valid responses. Data were collected via an online survey which collected information on general health status, comorbidities, experiences of PASC symptoms and health-related quality of life. Health-related quality of life was assessed through the EQ-5D instrument. A $20 e-gift card was given to each participant as compensation. Ordinary least squares regression was employed to examine the association between the number of PASC symptoms, comorbidities, and health-related quality of life, controlling for age, gender identity, and race/ethnicity. The study protocol received approval from the Institutional Review Board (IRB) from the City University of New York.
Results: The participants had an average age of 48.1 years (SD=10.5). The sample consisted of 54% cisgender males, 34% cisgender females, and 12% transgender/gender-diverse individuals, and 53% identified as sexual minorities. The largest racial/ethnic group was non-Hispanic Black (45%), followed by Hispanic (43%). Most PLWH (90%) reported undetectable HIV viral loads. On average, participants reported 2.2 comorbidities in addition to HIV (SD=1.5), and 42% rated their health as good/excellent. Nearly half (49%) reported one or more PASC symptoms lasting six months or more (M=5.3, SD=8.0). The number of PASC symptoms was significantly associated with poorer health-related quality of life (β=.33, R2=.31), with more variance in health-related quality of life than comorbidities and self-rated health combined (βs=.32 and .28, respectively, R2=.14).
Conclusions: PASC adversely affected health-related quality of life among people living with HIV. Routine assessment for PASC symptoms should be a standard practice in clinical settings for people living with HIV who have been diagnosed with COVID-19. These findings also underscore the importance of ongoing support for PLWH with a history of COVID-19 infection, and the need to focus on domains of health beyond HIV.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Peluso MJ, Antar AAR. Long COVID in people living with HIV. Curr Opin HIV AIDS. 2023;18(3):126-134. doi:10.1097/COH.0000000000000789
3. Aiyegbusi OL, Hughes SE, Turner G, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021;114(9):428-442. doi:10.1177/01410768211032850
4. Ford ND, Slaughter D, Edwards D, et al. Long COVID and Significant Activity Limitation Among Adults, by Age - United States, June 1-13, 2022, to June 7-19, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(32):866-870. Published 2023 Aug 11. doi:10.15585/mmwr.mm7232a3
5. Groff D, Sun A, Ssentongo AE, et al. Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review. JAMA Netw Open. 2021;4(10):e2128568. Published 2021 Oct 1. doi:10.1001/jamanetworkopen.2021.2856
6. Malesevic S, Sievi NA, Baumgartner P. et al. Impaired health-related quality of life in long-COVID syndrome after mild to moderate COVID-19. Sci Rep. 2023; 13(7717). Published 2023 May 12. doi:10.1038/s41598-023-34678-8
7. Kim Y, Bae S, Chang HH, Kim SW. Long COVID prevalence and impact on quality of life 2 years after acute COVID-19 [published correction appears in Sci Rep. 2023 Jul 24;13(1):11960. doi: 10.1038/s41598-023-39132-3]. Sci Rep. 2023;13(1):11207. Published 2023 Jul 11. doi:10.1038/s41598-023-36995-4
8. Bergner M. Quality of life, health status, and clinical research. Med Care. 1989;27(3 Suppl):S148-S156. doi:10.1097/00005650-198903001-00012
9. Yin S, Njai R, Barker L, Siegel PZ, Liao Y. Summarizing health-related quality of life (HRQOL): development and testing of a one-factor model. Popul Health Metr. 2016;14:22. Published 2016 Jul 11. doi:10.1186/s12963-016-0091-3
10. Carlile O, Briggs A, Henderson AD, et al. Impact of long COVID on health-related quality-of-life: an OpenSAFELY population cohort study using patient-reported outcome measures (OpenPROMPT). Lancet Reg Health Eur. 2024;40:100908. Published 2024 Apr 24. doi:10.1016/j.lanepe.2024.100908
11. O' Mahony L, Buwalda T, Blair M, et al. Impact of Long COVID on health and quality of life. HRB Open Res. 2022;5:31. Published 2022 Apr 22. doi:10.12688/hrbopenres.13516.1
12. Walker S, Goodfellow H, Pookarnjanamorakot P, et al. Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study. BMJ Open. 2023;13(6):e069217. Published 2023 Jun 7. doi:10.1136/bmjopen-2022-069217
13. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525-1533. doi:10.1016/S0140-6736(13)61809-7
14. Swendeman D, Ingram BL, Rotheram-Borus MJ. Common elements in self-management of HIV and other chronic illnesses: an integrative framework. AIDS Care. 2009;21(10):1321-1334. doi:10.1080/09540120902803158
15. Korthuis PT, Zephyrin LC, Fleishman JA, et al. Health-related quality of life in HIV-infected patients: the role of substance use. AIDS Patient Care STDS. 2008;22(11):859-867. doi:10.1089/apc.2008.0005
16. Seguiti C, Salvo PF, Di Stasio E, et al. Health-related quality of life (HRQoL) from HIV patients' perspective: comparison of patient-reported outcome (PRO) measures among people living with hiv (PLWH) and other chronic clinical conditions. J Patient Rep Outcomes. 2022;6(1):27. Published 2022 Mar 26. doi:10.1186/s41687-022-00423-4
17. Nigusso FT, Mavhandu-Mudzusi AH. Health-related quality of life of people living with HIV/AIDS: the role of social inequalities and disease-related factors. Health Qual Life Outcomes. 2021;19(1):63. Published 2021 Feb 25. doi:10.1186/s12955-021-01702-2
18. Dutra BS, Lédo AP, Lins-Kusterer L, Luz E, Prieto IR, Brites C. Changes health-related quality of life in HIV-infected patients following initiation of antiretroviral therapy: a longitudinal study. Braz J Infect Dis. 2019;23(4):211-217. doi:10.1016/j.bjid.2019.06.005
19. Amboise Y, Yaya I, Yombo-Kokule L, et al. Perceived health-related quality of life in people living with HIV co-infected with SARS-CoV-2 in France. Qual Life Res. Published online June 12, 2024. doi:10.1007/s11136-024-03701-4
20. Danwang C, Noubiap JJ, Robert A, Yombi JC. Outcomes of patients with HIV and COVID-19 co-infection: a systematic review and meta-analysis. AIDS Res Ther. 2022;19(1):3. Published 2022 Jan 14. doi:10.1186/s12981-021-00427-y
21. Wu Y, Mattas E, Brandenburg C, et al. The association of sociodemographic characteristics and comorbidities with post-acute sequelae of SARS-CoV-2 in a Medicaid managed care population with and without HIV. PLoS One. 2024;19(7):e0306322. Published 2024 Jul 25. doi:10.1371/journal.pone.0306322
22. Tran VT, Riveros C, Clepier B, et al. Development and Validation of the Long Coronavirus Disease (COVID) Symptom and Impact Tools: A Set of Patient-Reported Instruments Constructed From Patients' Lived Experience. Clin Infect Dis. 2022;74(2):278-287. doi:10.1093/cid/ciab352
23. EuroQol Research Foundation. EQ-5D-5L User Guide, 2019. Available from: https://euroqol.org/publications/user-guides.
24. Arizpe A, Ochoa-Dominguez CY, Navarro S, et al. Racial/Ethnic Disparities: Discrimination's Impact on Health-Related Quality of Life-An All of Us Cancer Survivors' Cross-sectional Study. J Racial Ethn Health Disparities. Published online April 23, 2024. doi:10.1007/s40615-024-02006-z
25. Lopez L 3rd, Hart LH 3rd, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021;325(8):719-720. doi:10.1001/jama.2020.26443
26. Crocker TF, Brown L, Clegg A, et al. Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. Qual Life Res. 2019;28(8):2041-2056. doi:10.1007/s11136-019-02149-1
27. Hong C, Queiroz A, Hoskin J. The impact of the COVID-19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review. J Int AIDS Soc. 2023;26(3):e26060. doi:10.1002/jia2.26060
28. Fisher KA, Mazor KM, Epstein MM, et al. Long COVID awareness and receipt of medical care: a survey among populations at risk for disparities. Front Public Health. 2024;12:1360341. Published 2024 May 30. doi:10.3389/fpubh.2024.1360341
29. Cooper E, Lound A, Atchison CJ, et al. Awareness and perceptions of Long COVID among people in the REACT programme: Early insights from a pilot interview study. PLoS One. 2023;18(1):e0280943. Published 2023 Jan 26. doi:10.1371/journal.pone.0280943
30. Li J, Zhou Y, Ma J, et al. The long-term health outcomes, pathophysiological mechanisms and multidisciplinary management of long COVID. Signal Transduct Target Ther. 2023;8(1):416. Published 2023 Nov 1. doi:10.1038/s41392-023-01640-z
31. Langebeek N, Kooij KW, Wit FW, et al. Impact of comorbidity and ageing on health-related quality of life in HIV-positive and HIV-negative individuals. AIDS. 2017;31(10):1471-1481. doi:10.1097/QAD.0000000000001511
32. Oursler KK, Goulet JL, Crystal S, et al. Association of age and comorbidity with physical function in HIV-infected and uninfected patients: results from the Veterans Aging Cohort Study. AIDS Patient Care STDS. 2011;25(1):13-20. doi:10.1089/apc.2010.0242
33. Yang X, Shi F, Zhang H, et al. Long COVID among people with HIV: A systematic review and meta-analysis. HIV Med. Published online September 10, 2024. doi:10.1111/hiv.13708
34. Brennan-Ing M, Seidel L, Rodgers L, et al. The Impact of Comprehensive Case Management on HIV Client Outcomes. PLoS One. 2016;11(2):e0148865. Published 2016 Feb 5. doi:10.1371/journal.pone.0148865