Predictors of Death and Survival Duration Among a Sample of Persons Living With HIV/AIDS

A follow-up study was conducted on a sample of 120 ethnically diverse HIV-positive men and women first interviewed in 2000. Participant survival and death rates were ascertained from death records and analyses were performed to identify demographic and psychosocial predictors of survival from the original data. Consistent with past studies, factors associated with survival were age, CD4 count, years HIV positive, and lower alcohol use. Two analyses identified use of professional counseling as a unique factor associated with reduced risk of death. Contrary to our hypotheses, the results from these analyses did not suggest that social groups with fewer economic and institutional resources or those with limited access to highly active retroviral therapy (HAART) therapies were at reduced risk of survival.     

Misleading Sexual Partners About HIV Status Among Persons Living with HIV/AIDS

Most people living with HIV/AIDS (PLWHA) disclose their serostatus to their sexual partners and take steps to protect their partners from HIV. Prior research indicates that some PLWHA portray themselves to their sexual partners as HIV-negative or otherwise misrepresent their HIV status. The aim of this study was to document the prevalence of misleading sexual partners about HIV status and to identify factors associated with misleading. A sample of 310 PLWHA completed a self-administered questionnaire assessing demographic information, disclosure, HIV knowledge, HIV altruism, psychopathy, and sexual risk behavior. Participants were also asked "Since you were diagnosed as having HIV, have you ever misled a sexual partner about your HIV status?" Overall, 18.6% of participants indicated that they had misled a sexual partner. Those who had misled a partner at some point since their diagnosis reported more current HIV transmission risk behaviors, including unprotected anal or vaginal sex with a partner who was HIV-negative or whose HIV status was unknown. Participants who had misled a partner did not differ from those who had not in terms of demographic characteristics. Individuals who had misled a partner scored significantly lower on a measure of HIV knowledge than those who had not misled a partner. HIV altruism and psychopathy were associated with sexual risk behavior, but did not differ between those who had misled and those who had not. Disclosure of HIV status can reduce HIV transmission, but only if people are candid. Interventions aimed at increasing knowledge and accurate disclosure may reduce the spread of HIV.     

Accuracy of Predictive Equations for Energy Expenditure in Mexicans Living With HIV/AIDS With and Without Antiretroviral Therapy

Introduction: Determination of the resting energy expenditure (REE) is essential for planning nutrition therapy in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to help to improve their nutrition status. We aim to evaluate the agreement and accuracy of prediction equations that estimate the REE in a Mexican population with a diagnosis of HIV/AIDS with and without antiretroviral therapy (ART). Methods: A cross‐sectional study in Mexican patients with HIV/AIDS with and without ART. Weight, height, and body composition measured with dual‐energy x‐ray absorptiometry were evaluated. The REE was determined with indirect calorimetry and estimated using the Mifflin–St Jeor (MSJ), Harris‐Benedict (HB), Schofield 1 and 2, Cunningham, Melchior 91, Melchior 93, and Batterham equations. The Bland‐Altman method assessed agreement between the real and estimated values, and the percent difference between these values was used to assess the prediction accuracy. Results: Sixty‐five adults without ART and 102 adults with ART were included. The mean REE (kcal/kg) was 24.8 ± 2.4 and 23.8 ± 3.6 in patients without and with ART, respectively. Good agreement and reliability were observed in the HB (intraclass correlation coefficient [ICC], 0.75; P < .05), Batterham (ICC, 0.79; P < .05), Schofield 1 (ICC, 0.74; P < .05), and Schofield 2 (ICC, 0.78; P < .05) results in individuals without ART. In individuals with ART, good agreement and reliability were observed with the HB equation (ICC, 0.76; P < .05). The MSJ equation showed good agreement with poor reliability (ICC, 0.05; P < .05). Conclusion: The equations with the best agreement and accuracy were Schofield 2, Batterham, and HB in individuals without ART and HB and MSJ in the population with ART.     

Smoking-Related Health Risks Among Persons With HIV in the Strategies for Management of Antiretroviral Therapy Clinical Trial

Objectives. We sought to determine smoking-related hazard ratios (HRs) and population-attributable risk percentage (PAR%) for serious clinical events and death among HIV-positive persons, whose smoking prevalence is higher than in the general population.Methods. For 5472 HIV-infected persons enrolled from 33 countries in the Strategies for Management of Antiretroviral Therapy clinical trial, we evaluated the relationship between baseline smoking status and development of AIDS-related or serious non-AIDS events and overall mortality.Results. Among all participants, 40.5% were current smokers and 24.8% were former smokers. Adjusted HRs were higher for current than for never smokers for overall mortality (2.4; P < .001), major cardiovascular disease (2.0; P = .002), non-AIDS cancer (1.8; P = .008), and bacterial pneumonia (2.3; P < .001). Adjusted HRs also were significantly higher for these outcomes among current than among former smokers. The PAR% for current versus former and never smokers combined was 24.3% for overall mortality, 25.3% for major cardiovascular disease, 30.6% for non-AIDS cancer, and 25.4% for bacterial pneumonia.Conclusions. Smoking contributes to substantial morbidity and mortality in this HIV-infected population. Providers should routinely integrate smoking cessation programs into HIV health care.Highly active antiretroviral therapy (HAART) for HIV has led to a decrease in AIDS-related events and deaths.^1–3 However, HIV-infected persons are also at risk for a variety of serious non–AIDS-defining diseases, including cardiovascular, renal, and hepatic disease, as well as certain cancers and infections not included in the AIDS case definition.^1,3–5 Studies conducted in the general population demonstrate that cigarette smoking increases the likelihood of many of these serious clinical conditions, including cardiovascular, pulmonary, and neoplastic diseases.^6,7 For example, smoking is a major risk factor for peripheral vascular and coronary artery disease, increasing the risk for cardiovascular disease (CVD) complications, including myocardial infarction and stroke.^6–8 Respiratory complications of smoking include chronic obstructive pulmonary disease and respiratory infections such as bacterial pneumonia or pulmonary tuberculosis.^6,7,9 Smoking increases the risk for many types of cancer, including cancers of the oral cavity, pharynx, esophagus, stomach, pancreas, larynx, lung, cervix, urinary bladder, and kidney.^6,7,10Studying smoking-related morbidity and mortality among persons with HIV is especially important because their smoking prevalence is higher than that of the general population. Twenty-one percent of US adults are current cigarette smokers,¹¹ but many recent studies have reported rates 2 or 3 times as high (46%–76%) among HIV-positive persons.^12–18 HIV-infected current smokers are reported to smoke an average of 6 to 23 cigarettes daily and to have smoked for an average of 23 to 24 years.^15,16,18,19Many smoking-related illnesses significantly affect HIV-infected persons. Lung cancer and other malignancies are important causes of death among persons with HIV.^20,21 HIV infection or use of antiretroviral drugs may contribute to CVD risk,^22,23 and use of effective HAART has resulted in increasing numbers of aging HIV-infected patients, who may develop metabolic syndrome, obesity, and other CVD risk factors.^24,25 HIV-infected patients may develop a variety of pulmonary diseases, including bacterial pneumonia^26,27; recurrent pneumonia is considered an AIDS-defining condition.²⁸Because persons with HIV are at risk for these serious and life-threatening clinical syndromes, critical prevention questions are whether and to what extent smoking further increases the risk of developing these diseases, especially in the era of HAART. Because smoking is a modifiable risk factor, it is important to define the magnitude of smoking''s effect on overall mortality among HIV-infected patients and its effect on development of specific adverse clinical conditions, including those that are not AIDS defining. It is also important to identify the proportion of disease among an HIV-infected population that is attributable to smoking. This information can be used to help estimate the effect of smoking cessation on reducing disease and improving survival for HIV-infected persons and to counsel individual patients about ways to optimize their health.We evaluated data from a large multisite international study of 2 HAART treatment strategies. We determined the relative risks associated with smoking for development of different serious clinical events and on all-cause mortality, with adjustment for a variety of important potential confounders. We also calculated the population-attributable risk percentage (PAR%) associated with smoking for these clinical syndromes and all-cause mortality.     

The Leisure Experiences of Older U.S. Women Living With HIV/AIDS

Although leisure is held to provide positive health benefits, structural and social obstacles deny equal participation to the disenfranchised. Employing quantitative and unique qualitative (e.g., Photovoice) methods, we examined the leisure behaviors of older women who were living in the United States and diagnosed with HIV/AIDS. Findings pointed to differences in time for, access to, and meaning of leisure in pre- vs. post-infection leisure for these women. As the disease progressed, however, each woman exhibited resilience in transcending systemic barriers to derive a spiritual view of leisure as a metaphor for the meaning of life. We believe our findings of spiritual transcendence will resonate among people living with HIV/AIDS throughout both Western and non-Western cultures.     

Nonadherence to Antiretroviral Therapy Among People Living with HIV/AIDS Attending Two Tertiary Care Hospitals in District of Northern India

Introduction:

Adherence to antiretroviral therapy is a principal predictor for the success of human immunodeficiency virus (HIV) treatment. It remains as a challenge to acquired immunodeficiency syndrome (AIDS) treatment and care with the widespread of the associated risks. Therefore, study aims to assess nonadherence level and factors associated with nonadherence to ART among people living with HIV/AIDS (PLHA).

Materials and Methods:

A hospital-based, cross-sectional study was conducted at two tertiary care hospital of Lucknow. A total of 322 adult HIV-positive patients registered in the ART center were included. Systematic random sampling was used to recruit patients. Nonadherence was assessed on the basis of pill count method.

Results:

A total of 10.9% of patients were found to be nonadherent to ART. Principal causes cited were being busy with other work (40.0%), felt sick or ill (28.5%), not having money (14.2%), and being away from home (11.4). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with nonbeneficial perceptions towards ART (odds ratio (OR) 18.5; 95% confidence interval (CI) 3.2-106.6; P = 0.001), being counseled for adherence for more than 3 months (OR 13.9; 95% CI 1.6-118.9; P = 0.01), presence of depression (OR 2.6; 95% CI 1.0-6.7; P = 0.04), and those who were not satisfied with healthcare facilities (OR 5.63; 95% CI 1.88-16.84; P = 0.00).

Conclusion:

Although adherence to ART varies between individuals and over time, the factors that affect nonadherence can be addressed with proper periodic counseling and motivation of patients and their family members. Adherence to highly active antiretroviral therapy (HAART) could delay the progression of this lethal disease and minimize the risk of developing drug resistance.     

Trajectory of Physical Functioning Among Persons Living With HIV in Nursing Homes

Objective(s)

To examine the change in physical functional status among persons living with HIV (PLWH) in nursing homes (NHs) and how change varies with age and dementia.

高效抗逆转录病毒治疗艾滋病方案的效果评价

目的评价目前高效抗逆转录病毒治疗(HAART)方案的疗效,为以后的治疗方案提供参考。方法应用国家免费提供的抗病毒治疗药品,对符合治疗条件的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病例进行规范的抗病毒治疗,并检测病例的病毒载量和淋巴细胞。结果治疗1～12个月,治疗病例CD4+T淋巴细胞计数呈明显上升趋势,均值为266.2;12个月之后,CD4+T淋巴细胞计数相对稳定,均值为353.1。治疗12个月前后,其差异具有统计学意义(P0.05)。治疗1～7个月,病例病毒载量计数呈明显下降趋势;治疗7个月之后,病例病毒载量计数相对变化较为稳定。治疗7个月前后,其差异有显著的统计学意义(P0.01)。结论浙江省艾滋病例在接受抗病毒治疗1年后,治疗效果明显,病例状态持续稳定。     

泰安市艾滋病病毒感染者/艾滋病患者生存状况

目的了解泰安市HIV/AIDS患者的生存状况,为制定相关的救治救助政策和干预措施提供科学依据。方法使用自行设计的调查问卷、焦虑自评量表、抑郁自评量表和社会支持评定量表对本地区能随访到的全部HIV/AIDS患者进行面对面的问卷调查。结果调查的36例HIV/AIDS患者感觉自己生活质量很好或较好的仅占22.22%,4/36评定有焦虑,13/36评定有抑郁,家庭收入低于当地农民平均水平;年龄小于30岁、最近1个月参与社交活动多、最近1次CD4细胞检测结果高、没有接受抗病毒治疗的HIV/AIDS患者自我感觉生活状况较好,差异有统计学意义(P<0.05)。结论HIV/AIDS患者自我感觉生活状况差,部分存在心理问题,经济收入较低,应进一步加大心理支持和社会救助。     

Risks of Recreational Exposure to Waterborne Pathogens Among Persons With HIV/AIDS in Baltimore, Maryland

Objectives. We assessed the prevalence of recreational activities in the waterways of Baltimore, MD, and the risk of exposure to Cryptosporidium among persons with HIV/AIDS.Methods. We studied patients at the Johns Hopkins Moore Outpatient AIDS Clinic. We conducted oral interviews with a convenience sample of 157 HIV/AIDS patients to ascertain the sites used for recreational water contact within Baltimore waters and assess risk behaviors.Results. Approximately 48% of respondents reported participating in recreational water activities (fishing, crabbing, boating, and swimming). Men and women were almost equally likely to engage in recreational water activities (53.3% versus 51.3%). Approximately 67% (105 of 157) ate their own catch or that of friends or family members, and a majority (61%, or 46 of 75) of respondents who reported recreational water contact reported consumption of their own catch.Conclusions. Baltimoreans with HIV/AIDS are engaging in recreational water activities in urban waters that may expose them to waterborne pathogens and recreational water illnesses. Susceptible persons, such as patients with HIV/AIDS, should be cautioned regarding potential microbial risks from recreational water contact with surface waters.Persons with HIV/AIDS are at high risk for increased morbidity and mortality associated with a range of opportunistic infections, some of which are caused by Cryptosporidium. Cryptosporidium species are of particular public health and medical importance because they are prevalent in surface waters of the United States,^1–7 are efficiently transmitted via water,⁸ and can be consumed in foods contaminated by fecal matter.^9–11 Exposures to Cryptosporidium are common in the US population,¹² and past studies have demonstrated that Cryptosporidium infections significantly contribute to illness and mortality in persons with HIV/AIDS.^13–15 In the 1980s, Cryptosporidium was identified as a major opportunistic pathogen.^16–21 Infection continues to be frequently diagnosed in persons with HIV/AIDS.^22–27 Before the advent of highly active antiretroviral therapy, Cryptosporidium was a relatively common opportunistic infection even in developed countries.^28,29Cryptosporidiosis manifests as an acute gastroenteritis, accompanied by cramps, anorexia, vomiting, abdominal pains, fever, and chills²⁹ and by histological presentation of gastrointestinal mucosal injury.^30,31 Persons with AIDS who become infected with this parasite are at increased risk of developing chronic and often life-threatening diarrhea, biliary tract diseases, pancreatitis, colitis, and chronic asymptomatic infection and recurrence. These developments are especially likely in those who are severely immunosuppressed (CD4 counts < 150 cells/mL).^29,32–35 Infection is diagnosed by the presence of oocysts in unpreserved or preserved stools.³⁶ Histological and ultrastructural examination of biopsy material for different Cryptosporidium life stages, detection of Cryptosporidium DNA and antigens, and identification of species through molecular techniques can also aid in diagnosis.^36–38Cryptosporidium species are enteric protozoan organisms and are prevalent in US watersheds, especially in urban waters.^1,6,39 These parasites have natural hosts in domestic and wild animals such as cattle (especially newborn calves), horses, fish, and birds.^5,40–42 These parasites cause cryptosporidiosis by infecting and damaging the cells of the small intestine and other organs.^13,41 For persons with HIV/AIDS, increased risk for infection by Cryptosporidium has been related to sexual practices such as engaging in sexual intercourse within the past 2 years, having multiple partners during that time, and engaging in anal intercourse.⁴³ Use of spas and saunas has also been identified as a risk factor.⁴³In the United States, Cryptosporidium is the most commonly identified pathogen in cases of recreationally acquired gastroenteritis⁴⁴; the majority of those affected are children. Increased risk of cryptosporidiosis in persons with HIV/AIDS has been associated with swimming.^45,46 US residents make an estimated 360 million annual visits to recreational water venues such as swimming pools, spas, and lakes; swimming is the second most popular physical activity in the country and the most popular among children.⁴⁷Recreational swimming, even in highly chlorinated water, carries a high risk of exposure to enteric pathogens, including Cryptosporidium, Norovirus, Shigella, Escherichia coli, and Giardia.⁴⁸ Cryptosporidiosis and some other enteric illnesses are seasonal, with spikes in occurrence in the summer months from contact with recreational water venues.⁴⁹ Extreme precipitation⁵⁰ and high ambient temperatures⁵¹ can also affect patterns of disease outbreaks. Because not all infections with Cryptosporidium lead to apparent illness or symptoms, infected persons may unknowingly transmit these pathogens to others, such as household members and other recreationists.^12,52 Cryptosporidiosis from swimming, wading, and splashing is prevalent in the United States.^44,46,53,54Risks from the presence of pathogens in waterways include (1) waterborne gastroenteritis and other recreational water illnesses in anglers and other recreationists^44,55–59; (2) transmission of pathogens to humans from caught seafood acting as fomites, or surface carriers⁶⁰; (3) food-borne gastroenteritis from consumption of raw or improperly cooked fish and shellfish^61,62; and (4) hand-to-mouth transmission of pathogens while eating, drinking, or smoking during activities such as fishing and crabbing.⁷Recreational water activities in the Baltimore, Maryland, area take place in Jones Falls and Baltimore Harbor. These and other waterways are used for angling, crabbing, swimming, kayaking, and boating (including paddle boating).^7,63 In addition, Baltimore-area residents often catch and consume fish and crabs from the Baltimore Harbor and local waterways, many of which are already highly contaminated by persistent chemicals such as mercury and polychlorinated biphenyls.⁶⁴ These activities are known to increase risks of exposure to waterborne pathogens through direct contact with contaminated waters or through contact with or handling and consumption of caught seafood (fish, crabs, oysters).^7,65,66To investigate the potential contribution of recreational water contact to Cryptosporidium exposures among persons with HIV/AIDS, we carried out a cross-sectional study at the Johns Hopkins Moore Outpatient AIDS Clinic. The Baltimore metropolitan area has a high prevalence rate of HIV/AIDS among both men and women,⁶⁷ and its population makes intensive recreational use of a contaminated watershed. In addition, laboratory experiments have indicated that crabs can become superficially contaminated by Cryptosporidium and transfer the pathogen to hands.⁶⁸ Local anglers are at risk from Cryptosporidium on wild-caught fish.⁷Our objective was to address the risks of exposure to Cryptosporidium for an urban subpopulation, persons with HIV/AIDS, as a result of recreational contact with Baltimore waterways. We also assessed the patterns and locations of recreational water activities in Baltimore waters.     

艾滋病病毒感染者和病人生存质量调查及相关因素分析

目的调查与评价艾滋病病毒感染者和病人的生存质量,分析影响其生存质量的因素。方法采用世界卫生组织生存质量简表（WHOQOL—BREF中文版）加上艾滋病相关条目。对300例艾滋病病毒感染者和病人与112例健康的配偶／固定性伴及吸毒同伴进行调查。结果艾滋病病毒感染者和病人各方面得分均显著低于健康的配偶／固定性伴及吸毒同伴（P〈0．01）,健康的配偶,固定性伴及吸毒同伴的生存质量的心理领域和社会关系领域显著得分低于全国其他城市常模人群（P〈0．01）。文化程度、CD4细胞计数及家庭年收入与艾滋病病毒感染者和病人生存质量呈正相关,吸毒及HIV检测前及与配偶,固定性伴发生性关系的频次与艾滋病病毒感染者和病人的生存质量呈负相关。结论艾滋病病毒感染者和病人总体生存质量较差,其性伴或吸毒同伴的生存质量的心理领域和社会关系领域得分也低于全国其他城市常模人群。     

Psychosocial Differences Between Urban and Rural People Living With HIV/AIDS

Abstract: During the past decade, many investigations have examined the life circumstances of people living with HIV disease. Most of these studies, however, have focused on HIV-infected people in large metropolitan areas. This study compares the psychosocial profiles of rural and urban people living with HIV disease. Anonymous, self-administered surveys were completed by 276 people with HIV/AIDS in a Midwestern state. The assessment instrument measured respondents' quality of life, perceptions of loneliness, social support, experiences with AIDS-related discrimination, access to services, and illness-related coping strategies. Compared with their urban counterparts, rural people with HIV reported a significantly lower satisfaction with life, lower perceptions of social support from family members and friends, reduced access to medical and mental health care, elevated levels of loneliness, more community stigma, heightened personal fear that their HIV serostatus would be learned by others, and more maladaptive coping strategies. Programs that are designed to improve the life circumstances of people with HIV disease in rural areas—particularly those that facilitate access to adequate health care, increase perceptions of social support, and improve illness-related coping—are urgently needed.     

男男性接触者艾滋病干预效果分析

目的了解干预后男男性接触者(MSM)人群的艾滋病相关知识、高危险行为和性病相关感染情况,评价干预效果。方法采用匿名问卷形式对MSM人群进行干预前及干预后6个月、12个月共3次横断面调查和血标本的采集检测H IV和梅毒。结果干预后艾滋病知识的知晓率有明显提高(P0.05),最高提幅达19.83%。2个以上性伴数的人数比例从84.79%下降为65.95%,保持单一的性伴数比例从15.21%上升至34.05%。最近1次肛交和最近6个月肛交时安全套的使用率分别从72.17%和43.04%上升至75.10%和45.20%。最近1年作过H IV检测比例从28.26%升至44.69%。H IV的感染率为0.87%~2.43%,梅毒感染率为8.18%~11.28%。结论针对MSM人群的宣传、干预措施,取得一定的效果,可推广使用。     

Rates and Predictors of Consistent Condom-use by People Living with HIV/AIDS on Antiretroviral Treatment in Uganda

Antiretroviral treatment (ART) has been recognized as one of the methods for reducing the risk of HIV transmission, and access to this is being rapidly expanded. However, in a generalized HIV epidemic, ART could increase unprotected sex by people living with HIV/AIDS (PHAs). This paper assessed the rates and predictors of consistent condom-use by sexually-active PHAs after initiating ART. The study used cross-sectional data on sexual behaviour of 269 sexually-active ART-experienced individuals (95 males and 174 females) aged 18 years and above. The results revealed that 65% (70% of men and 61% of women) used condom consistently after initiating ART. Consistent use of condom was more likely if PHAs had secondary or tertiary-level education and had more than one sex partner in the 12 months preceding the study. However, PHAs were less likely to have used condom consistently if they worked in the informal and formal sectors, belonged to the medium and high-income groups, and were married. PHAs, who were on ART for less than 1 year and 1-2 year(s), had a good self-perception of health, had a sexual partner who was HIV-negative or a partner with unknown HIV status, and desired to bear children, were also less likely to have used condom consistently. The paper concluded that, although the majority of PHAs consistently used condom, there was potential for unprotected sex by PHAs on ART.Key words: Antiretroviral treatment, Condom-use, PHAs, Uganda     

HIV感染者／病人心理状态与需求调查

目的了解HIV感染者的心理与生活状况以及社会需求。方法通过面对面交谈方式,完成预先设计好的调查表。结果感染者普遍存在心理压力大,社会歧视严重,生活贫困和就医困难等问题。结论感染者需要得到社会的关爱,感染者的生活质量应引起社会的重视。     

Quality of Life of People With HIV/AIDS Receiving Antiretroviral Therapy in Cuba: A Cross-Sectional Study of the National Population

Objectives. We studied the effect of antiretroviral therapy (ART) on the quality of life (QOL) of Cubans with HIV/AIDS.Methods. We conducted a cross-sectional study including administration of the Medical Outcomes Study–HIV Health Survey Questionnaire to a representative sample of the 1592 Cubans receiving ART in 2004. For univariate analyses, we compared mean HIV scale scores. We used logistic regression models to estimate the association between role function and year of diagnosis, between pain and sex, and between health transition and region of diagnosis, with adjustment for demographics, ART regimen, and clinical status.Results. There were 354 participants (73 women, 281 men). Scores for all functional activities showed means higher than 80 out of 100. Pain interfered more in women than in men (73.2 vs 81.9; P = .01). When HIV diagnosis occurred after 2001, the probability of experiencing difficulties performing work (odds ratio [OR] = 4.42; 95% CI = 1.83, 10.73) and pain (OR = 1.70; 95% CI = 1.01, 2.88) increased compared with earlier diagnosis. People treated with indinavir showed a greater perception of general health (58.9 vs 52.4; P = .045) and greater health improvement (78.6 vs 67.8; P = .002).Conclusions. Although Cubans receiving ART are maintaining a high QOL, we observed significant differences by sex and time of diagnosis. QOL assessment can serve as a health outcome and may allow identification of QOL reductions potentially related to ART side effects.In the Caribbean region, which is characterized by the highest prevalence of HIV outside of sub-Saharan Africa, AIDS is one of the main causes of adult death.1 Cuba has an estimated adult prevalence of HIV of 0.1%—the lowest in the Caribbean and the rest of the Americas—despite a rising HIV incidence.1 Transmission occurs fundamentally among men who have sexual intercourse with other men.2 Cuba is a country with a high development index and a low proportion of people below certain deprivation threshold levels in each of the dimensions of the high development index, as measured by the human poverty index.3Between 1986 and 1994, life in AIDS sanatoria was mandatory for all Cubans diagnosed with HIV—a contentious policy that generated multiple debates.4–7 Sanatoria were originated to provide medical and psychological care and to train people to live with HIV and to cope with the impact of the diagnosis.8,9 Whereas some authors argue that the quarantine contributed to the slow growth of the epidemic in Cuba,2,10 other studies have associated its low-level transmission with high condom use and an intensive policy of HIV testing, counseling, contact tracing, and active follow-up of all people diagnosed with HIV.2 Because of the human and social cost of quarantine, an outpatient care system was initiated in 199411 with the aim of reintroducing people with HIV back into society. By the end of 2008, 74% of those diagnosed with HIV in Cuba received ambulatory care and 26% either lived in sanatoria—now called Centers for Comprehensive Care for People with HIV/AIDS—or were staying there temporarily while they received training on how to live with HIV.12 This training, which is also provided to those in ambulatory care, consists mostly on how to eat a healthy diet, maintain good personal hygiene, keep medical appointments, complete examinations, adhere to treatment, avoid substance use, and prevent HIV transmission and reinfection. To ensure appropriate nutrition, people with HIV are entitled to additional food rations.11Until 1996, some patients received antiretroviral (ARV) monotherapy or dual therapy and, between 1996 and 2001, a small number of patients received triple antiretroviral therapy (ART), mostly through donations. Since 2001, after the Cuban government started to produce generic ARVs,11 ART became the standard regimen, free of cost to the patient.2,11 Nationally produced ARVs included zidovudine (AZT), lamivudine (3TC), stavudine (d4T), indinavir (IDV), didanosine (DDI), and nevirapine (NVP). A greater number of therapeutic combinations was introduced in 2003, when a grant from the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) allowed the purchase of additional ARVs. In 2003, Cuba achieved universal access to ART11 for all those who met clinical eligibility criteria; that is, HIV infection with a CD4 count less than 350 cells per cubic millimeter with or without opportunistic infections; an AIDS-defining illness such as lymphoma, tuberculosis, or Kaposi’s sarcoma independent of viral load; or a viral load of at least 55 000 copies per milliliter. As of May 2009, 73.4% of patients receiving ART were treated with generic medications manufactured in Cuba, 0.8% with ARVs purchased through the GFATM, and 25.8% with a mix of Cuban generics and ARVs purchased through the GFATM.12In Cuba, the use of ART has proven to be effective, improving immunologic parameters, increasing survival, and diminishing the occurrence of opportunistic infections and AIDS-related mortality11,13—even though development of drug resistance and treatment failure, associated with nonadherence to ART, have been documented.14,15 Now that HIV infection is a chronic illness, quality of life (QOL) assessment can serve as a health outcome and may also allow clinicians and other health workers to identify any reductions in QOL potentially related to short- and long-term side effects of ART. Because nonadherence can be potentially related to reductions in QOL linked with side effects,16 its resulting increased viral load may also have a public health impact in terms of increasing the likelihood of transmission of HIV.17 Although the impact of ART on QOL was explored in a qualitative study among pregnant women in Cuba,18 this article presents the first quantitative study of the effect of the provision of ART on QOL of a nationally representative sample of people living with HIV/AIDS in Cuba.