Measuring the health-related quality of life in HIV patients with integrase strand transfer inhibitor-based regimens in China

Measuring the health-related quality of life in HIV patients with integrase strand transfer inhibitor-based regimens in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Measuring the health-related quality of life in HIV patients with integrase strand transfer inhibitor-based regimens in China Wei Tang, Yaxiong Huang, Hui Qi, Zhong Chen, Fang Zheng, Guoqiang Zhou, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4635838/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background With bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), and dolutegravir/lamivudine (DTG/3TC) included in the national drug reimbursement list, the integrase strand transfer inhibitor (INSTI)-based regimens could be afforded and used by more patients. Majority of previous health-related quality of life (HRQoL) studies were conducted before INSTI-based regimens reimbursed and have no restriction on the regimens received. The aim of the study is to measure the HRQoL of HIV patients with INSTI-based regimens in China. Methods A cross-sectional survey of HIV patients conducted in the First Hospital of Changsha. Adult patients diagnosed with HIV-1 infection between January 1 st , 2021-July 31 st , 2022, with the prescription of BIC/FTC/3TC or DTG/3TC as the current treatment were included. Patients’ responses were collected through a digital platform and the HRQoL were measured by three questionnaires, including HIV-symptom index (HIV-SI) questionnaire, Patient Health Questionnaire‐9 (PHQ-9) and the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L). Generalized linear regression model was used to estimate the effects of covariates on each HRQoL measure. Results A total of 143 HIV patients with HRQoL data available were included in the study. The mean (SD) of HIV-SI total score, PHQ-9 total score and EQ-5D utility score was 26.7 (14.4), 7.4 (1.0) and 0.95 (0.12), respectively. Compared with treatment-naive patients, treatment-experienced patients reported significantly higher score/proportion of HIV-SI and PHQ-9 total score, presence of depression and problems in anxiety/depression (all p<0.05). Patients with older age, without formal work, having treatment switch due to safety reason and lower CD4 cell counts had significantly higher HIV symptom burden and worse depression status, respectively (all p<0.05). Conclusions HIV patients suffer from HIV symptoms and depression, which greatly deteriorate their HRQoL. Considering the aging population and lower employment rate, the needs for social support or patient-assistant program for HIV patients are highlighted. The early initiation of INSTI-based regimens is necessary to avoid the HRQoL loss due to safety reasons. HIV INSTI-based STRs HRQoL depression China Background HIV imposes a great disease burden in China. As reported by China Center for Disease Control and Prevention (CDC), around 1.22 million patients living with HIV/AIDS, with accumulative death of 418 thousand cases by end of 2022[ 1 ]. An increasing trend of the HIV/AIDS incidence was observed from 2010 to 2022, especially in the age group ≥ 50 years, highlighting the ongoing challenges of HIV/AIDS control in China[ 2 ]. Antiretroviral therapy (ART) has been widely used in HIV treatment to reduce the mortality and morbidity of HIV patients in China. According to the Chinese Guidelines for Diagnosis and Treatment of Human Immuodeficiency Virus Infection/Acquired Immunoeficiency Syndrome (2021 Edition), the regimen containing two nucleoside reverse transcriptase inhibitors (NRTIs) plus a third drug (a non-nucleoside reverse transcriptase inhibitor [NNRTI], or a boosted protease inhibitor [PI] or an integrase strand transfer inhibitor [INSTI]) are recommended[ 3 ]. Specifically, bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/c/FTC/TAF) and dolutegravir/lamivudine (DTG/3TC) are the INSTI-based single-table regimens (STRs) included in the National Reimbursement Drug List (NRDL) in China[ 4 ]. With the reimbursement from government, patients’ out-of-pocket payment is reduced significantly and subsequently the INSTI-based STRs could be afforded and used by more patients. Though with innovative ART, HIV patients suffer from depression, anxiety, financial stress and HIV-related discrimination, which greatly reduce their health-related quality of life (HRQoL). The HRQoL is evaluated through the patient-reported outcomes. Various patient-reported outcome (PRO) measures could be utilized to support HIV management by capturing patients’ ART experience accurately, evaluating and differentiating treatment strategy and predict clinical outcomes[ 5 ]. Previous studies have evaluated and found the low HRQoL and associated factors in HIV patients [ 6 – 9 ]. Nevertheless, majority of the studies were conducted before BIC/FTC/TAF or DTG/3TC included in NRDL and have no restriction on the regimen received. A single-center, prospective study was conducted to evaluate the PRO in HIV patients with BIC/FTC/TAF in southwest China, while several limitations constrain the generalizability of the study findings including lack of HIV patients with other INSTI-based regimens, without multivariate analysis of PRO data and no EQ-5D utility score generated and analyzed in the study[ 10 ]. Considering the better efficacy, safety and persistence profile of INSTI-based STRs, the aim of the study is to measure the HRQoL of HIV patients with INSTI-based STRs in China[ 11 – 14 ]. Methods Study design This is a cross-sectional survey of HIV patients in the Department of Infection in First Hospital of Changsha to evaluate the health-related quality of life of patients with INSTI-based regimens. The hospital is a tier 3A hospital in Hunan Province, covering the majority of the treatment of HIV/AIDS patients in the province. This study followed the principles of Declaration of Helsinki and the ethical approval was obtained from the Central Institutional Review Board of the First Hospital of Changsha in Hunan province. Study population Adult patients diagnosed with HIV-1 infection between January 1st, 2021 and July 31st, 2022, with the prescription of BIC/FTC/3TC or DTG/3TC as the current treatment were included in the study. Patients with pregnancy or severe infections, or unable to complete the HRQoL questionnaires were excluded. The patients’ responses were collected through a digital platform with the access through wechat, the widely used social media platform in China. Patients answered each question of the PRO measures by themselves to avoid proxy bias[ 15 ]. All patients participated in the study signed the informed consent form. HRQoL measures Patients’ HRQoL were measured by three questionnaires, including HIV-symptom index (HIV-SI) questionnaire, Patient Health Questionnaire-9 (PHQ-9) and the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L). As a validated PRO instrument, HIV Symptom Index (HIV-SI) evaluates the impact of 20 symptoms associated with HIV infection or treatment[ 16 ]. Participants rated their experiences for each of the 20 symptoms with a 5-poin scale from 0 (I don’t have this symptom) to 4 (I was bothered a lot). The 20 symptoms included fatigue/energy loss, insomnia, tension/anxiety, diarrhea, changes in body composition, feeling sad/depressed, abdominal distension/stomachache/flatulence, muscle soreness/joint pain, decreased sexual ability, poor memory, headache, hand/foot pain/numbness/tingling, skin problems/rash/itching, cough/difficulty breathing, fever/chills/sweating, dizziness, weight loss/weight gain, nausea/vomiting, alopecia, and loss of appetite/loss of food taste. The sum of each symptom’s score was calculated and a higher total score indicated a higher symptom burden. The Chinese version of HIV-SI has been applied in previous HIV study[ 10 ]. The PHQ-9 assessed the participant’s depressive status from 9 symptoms with a 4-point scale from 0 (not any) to 3 (almost every day). The 9 symptoms included anhedonia, depressed emotion, sleep trouble, fatigue, changes in appetite, low self-esteem, concentration troubles, psychomotor problems, and suicidal thoughts. The sum of each symptom’s score was calculated and a higher score indicated a higher depressive status. The presence of depression was classified with a cut-off value of 5[ 10 ]. The PHQ-9 had been proven to be a reliable and valid tool to detect depression in Chinese patients[ 17 , 18 ]. EQ-5D-5L is a widely used preference-based instrument with a descriptive of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L is developed from the widely used EQ-5D-3L with an expansion of 3 levels (no, moderate and extreme problems) to 5 levels (no, slight, moderate, severe, and extreme problems) in each dimension. Compared with EQ-5D-3L, the EQ-5D-5L were shown to have better efficiency in Chinese HIV patients[ 19 ]. The health utility score was calculated with a published national value set in Chinese population[ 20 ]. Statistical analysis Continuous variables were reported with mean and standard deviation (SD). Categorical variables were reported with count (frequency) and percentage. T-test and chi-square test were used in between group comparisons for continuous variables and categorical variables, respectively. Generalized linear regression was used to estimate the effects of covariates on each HRQoL measure. Age group, education, work status, comorbidity status, viral load, CD4 cell counts, Length of HIV diagnosis to ART initiation, length of disease, treatment history, and current treatment regimen were included as the covariates in the model. All statistical analysis were performed with SPSS® version 26.0 (IBM Corp., Armonk, NY). The statistical significance of all tests was assessed with a significance level of 0.05. Results The patient demographic and clinical characteristics are shown in Table 1 . A total of 143 HIV patients with HRQoL data available were included in the study. The mean (SD) age were 31.2 (7.5) years old, with the majority of patients as male (98.6%), with university education (74.8%) and formal work (53.8%). 16.8% of patients were with comorbidity and 85.3% of patients were with BIC/FTC/TAF as the current treatment regimen (85.3%). 63.6% of patients were treatment experienced, among which 42.7% had the treatment switch due to safety reason. 49.7% and 86.0% of patients were with CD4 cell counts > 500 cells/µL and viral suppressed (defined as viral load ≤ 200 copies/ml), respectively. The mean (SD) length of disease were 3.1 (3.1) years and about half patients (55.2%) initiated the ART within 30 days from HIV diagnosis. The total score/health utility and symptom/domain score of HIV-SI, PHQ-9 and EQ-5D-5L are shown in Table 2 . The mean (SD) of HIV-SI total score, PHQ-9 total score and EQ-5D utility score was 26.67 (14.40), 7.35 (0.95) and 0.95 (0.12), respectively. In terms of HIV-SI, more than 50% of patients reported bothersome in fatigue/loss of energy (65.7%), nausea/vomiting (60.1%), coughing/trouble breathing (52.4%), headaches (57.3%), loss of appetite (59.4%), bloating/pain/gas in stomach (63.6%), skin problems/rash/itching (50.3%), changes in body composition/weight gain (50.3%), and hair loss/changes (50.3%). Compared with treatment-naïve patients, treatment-experienced patients reported significantly higher proportion with bothersome in pain/numbness/tingling in hands/feet, nausea/vomiting, headache, loss of appetite, bloating/pain/gas in stomach, trouble remembering, skin problems/rash/itching, changes in body composition/weight gain, and hair loss/changes (all p < 0.05). According to the responses to PHQ-9 and EQ-5D-5L, 65.0% of patients reported the presence of depression, while 29.4% of patients reported problems with anxiety/depression among the EQ-5D domains. Compared with treatment-naive patients, treatment-experienced patients reported significantly higher score/proportion of PHQ-9 total score, presence of depression and problems in anxiety/depression (all p < 0.05). The generalized linear model of health utility, PHD-9 and HIV-SI total score are shown in Table 3 . Patients with older age, (HIV-SI: beta = 5.86, standard error [SE] = 2.40, p = 0.015; PHQ-9: beta = 2.14, SE = 0.81, p = 0.008), without formal work (HIV-SI: beta = 6.98, SE = 2.25, p = 0.002; PHQ-9: beta = 2.69, SE = 0.76, p < 0.001), and having treatment switch due to safety reason (HIV-SI: beta = 6.53, SE = 3.16, p = 0.039; PHD-9: beta = 2.26, SE = 1.06, p = 0.032) had significantly higher HIV symptoms and worse depression status, respectively. Lower CD4 cell counts was also associated with worse depression status (PHQ-9: beta = 3.16, SE = 1.18, p = 0.007). Apart from older age (beta=-0.05, SE = 0.02, p = 0.013), no formal work (beta=-0.05, SE = 0.02, p = 0.008), with comorbidity (beta=-0.06, SE = 0.02, p = 0.021), lower education level (beta=-0.06, SE = 0.02, p = 0.006) and longer ART initiation time (30–90 days: beta=-0.05, SE = 0.02, p = 0.025; >90 days: beta=-0.06, SE = 0.03, p = 0.030) were also found to be associated with worse utility score significantly. Discussion To our knowledge, this is the first study to explore the HRQoL in HIV patients with INSTI-based regimens in China. The prevalence of depression measured by PHQ-9 was reported as 65.0% in our study. Considering depression impairing patients’ social function and decreasing medication adherence, screening and management of depression might good to be integrated into the routine HIV care[ 21 , 22 ]. Moreover, The association between employment and depression shown in our study was consistent with previous studies in China [ 23 – 25 ]. Due to poor health condition, discrimination and stigma, HIV faced the great challenge of unemployment. Nevertheless, the employment status has been shown to play a critical role in the timely HIV diagnosis, linkage to HIV care and HIV medication adherence [ 26 – 31 ]. Considering the lower employment rate of HIV patients in China compared with western countries, the needs for social support or patient-assistant program for HIV patients are highlighted[ 23 , 32 ]. Our study results showed patients with lower CD4 cell counts had significantly more problems with HIV symptoms and worse depression status, which was consistent with previous studies[ 33 – 35 ]. Nevertheless, the finding is different from that of several China studies reporting no association between CD4 cell counts and depression[ 24 , 36 ]. One possible reason is the different depression measures used in our study (PHQ-9) and previous studies (Hospital Anxiety and Depression Scale [HADS]). Both PHD-9 and HADS depression subscale are reliable and valid, while they differed significantly in categorizing depression severity with PHQ-9 categorizing more patients with moderate-to-severe depression[ 37 ]. Therefore, the depression status difference among CD4 cell count level might be better captured. Another possible reason is the previous studies conducted before BIC/FTC/TAF or DTG/3TC included in NRDL list and most of the treatment regimens patients received were not INSTI-based regimens. For example, all patients were with EFV-based regimens in the study published in 2022[ 36 ]. Compared with EFV-based regimens, BIC/FTC/TAF had a significantly higher CD4 cell counts increase, indicating a better immune reconstitution in Chinese HIV patients. As a result, the change in the immune function might be more obvious in the patients with INSTI-based regimens in our study, compared with those in previous studies. Nevertheless, given the small number of publications, further studies might be needed for exploration. The association between treatment switch due to safety reason and depression highlighted the importance for initiation of INSTI-based regimens. Our study results showed the quality of life of these patients after switch still worse than those with the initiation of INSTI-based regimen, which is supported by the limited change of depression severity after EFV switch shown in previous studies[ 38 – 41 ]. Though EFV-induced central nervous system (CNS) adverse events usually appear early and might diminish within the 1st month of treatment, the adverse events persist in a significant proportion of EFV patients[ 42 , 43 ]. These findings indicated the necessity to initiate INSTI-based regimen with better safety profile rather than resolving the depression problem by treatment switch ineffectively. Though previous studies have shown the ART side effects are associated with poor quality of life, generic EFV and generic LPV-based regimens are recommended as the first-line treatment regimens and widely used in clinical practice. Considering 40%-60% of HIV patients treated with EFV suffering from the related CNS adverse events, the ART imitation with EFV might not be an optimal choice[ 43 ]. There are some limitations in the study. Firstly, the study findings only represented the HRQoL of HIV patients in the hospital in Hunan province and might not be generalized to PLHW in other cities/provinces in China. Secondly, due to the lack of longitudinal data, the association between demographic, clinical characteristics and PRO measures rather than the causal effects were assessed in the study. Further analysis might be conducted with longitudinal data in future study. Thirdly, there was a limited number of female HIV patients in our study, which might constrain the generalizability of the study findings. Conclusions In summary, HIV patients suffer from HIV symptoms and depression, which greatly deteriorate their HRQoL. Considering the aging population and lower employment rate, the needs for social support or patient-assistant program for HIV patients are highlighted. Meanwhile, the early initiation of INSTI-based regimens is necessary to avoid the HRQoL loss due to safety reasons. Abbreviations Abbreviation Full name ART antiretroviral therapy BIC/TAF/TAF bictegravir/emtricitabine/tenofovir CDC Center for Disease Control and Prevention CNS central nervous system DTG/3TC dolutegravir/lamivudine EQ-5D-5L the five-level version of the EuroQol five-dimensional questionnaire EFV efavirenz EVG/c/FTC/TAF elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide HADS Hospital Anxiety and Depression Scale HIV-SI HIV-symptom index (HIV-SI) questionnaire HRQoL health-related quality of life INSTI integrase strand transfer inhibitor PHQ-9 Patient Health Questionnaire‐9 NRDL The National Reimbursement Drug List NRTI nucleoside reverse transcriptase inhibitors NNRTI non-nucleoside reverse transcriptase inhibitor PI protease inhibitor SD standard deviation SE standard error STR single-table regimen Declarations Ethics approval and consent to participate This study was performed in accordance with the Declaration of Helsinki. The ethics committee of the First Hospital of Changsha approved the study protocol. The data used in this study was anonymized before its use. The need for informed consent was waived by the ethics committee/Institutional Review Board of the First Hospital of Changsha because of the retrospective nature of the study. Consent for publication Not applicable. No individual person’s data was shown separately and all data are presented as a whole. Availability of data and material The data that support the findings of this study are available from the corresponding author on reasonable request. Participant data without names and identifiers will be made available after approval from the corresponding author. After publication of study findings, the data will be available for others to request. The research team will provide an email address for communication once the data are approved to be shared with others. Competing interests The authors declare no competing interests. Funding The study was supported by grants of the National Major Infectious Prevention and Treatment Program in the 13th Five-Year Plan (2018zx10302104-001) and Special Foundation for Innovation Development in Hunan Province (2020SK21362). The funding bodies had no role in the design of the study, data collection, data analysis and interpretation, and in writing the manuscript. Author contributions statement TW, HY, QH, CZ, ZF and CJ were responsible for the study concept and design, data collection, data analysis and interpretation, and manuscript drafting. ZG, XG and CJ were responsible for the critical revision of manuscript and final approval for publication. All authors read and approved the final manuscript. Acknowledgements We would like to express our appreciation for all the patients included in this study as well as their families. References HIV infection, mortality rates in China stand at low level globally. The State Council, the People's Republic of China. https://english.www.gov.cn/news/202311/30/content_WS65686e0fc6d0868f4e8e1c4d. html Accessed on May 28th , 2024. 2023. Hou Y et al. Comparative Analysis of Epidemiological Features of HIV/AIDS Cases Aged Over and Under 50 Years Old - China, 2010–2022. China CDC Wkly, 2023. 5(48): pp. 1079–1083. [Chinese guidelines for diagnosis and treatment of HIV/AIDS (2021 edition)]. Zhonghua nei ke za zhi, 2021. 60(12): p. 1106–28. The National Healthcare Security Administration. A renewed catalog of drugs covered by its national medical insurance system. http://www.nhsa.gov.cn/art/2023/12/13/art_53_11674.html Accessed on May 24th, 2024. Kall M, et al. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV. 2020;7(1):e59–68. Xie M, et al. Effects of Perceived Social Support on Health-Related Quality of Life in Asymptomatic and Symptomatic People Living with HIV in China: A Cross-Sectional Study. Curr HIV Res. 2023;21(1):63–72. Zhong H, et al. Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study. Front Public Health. 2023;11:1133657. Wang X, et al. The role of personality, social economic and prevention strategy effects on health-related quality of life among people living with HIV/AIDS. Infect Dis Poverty. 2021;10(1):104. Liu K, et al. Sexual orientation and quality of life of people living with HIV/AIDS in China: evidence from an institutional-based cross-sectional study. Qual Life Res. 2022;31(1):125–34. Kong L, et al. Clinical efficacy, safety, and subjective experience based on ePRO in HIV-infected individuals administered Bictegravir/Emtricitabine/Tenofovir Alafenamide in southwest China. Immun Inflamm Dis. 2023;11(8):e974. Jing C, et al. Treatment persistence of bictegravir/emtricitabine/tenofovir alafenamide and efavirenz + lamivudine + tenofovir disoproxil among HIV-1 patients newly starting treatment in Hunan Province in China. BMC Infect Dis. 2023;23(1):396. Wang R, et al. Rapid Initiation of Antiretroviral Therapy with Coformulated Bictegravir, Emtricitabine, Tenofovir Alafenamide Versus Efavirenz, Lamivudine and Tenofovir Disoproxil Fumarate in HIV-positive Men Who Have Sex with Men in China: Week 48 Results of the Multicenter, Randomized Clinical Trial. Clin Infect Dis; 2024. Dorward J, et al. Implementation and outcomes of dolutegravir-based first-line antiretroviral therapy for people with HIV in South Africa: a retrospective cohort study. Lancet HIV. 2023;10(5):e284–94. Deng L, et al. Dolutegravir plus lamivudine versus efavirenz plus tenofovir disoproxil fumarate and lamivudine in antiretroviral-naive adults with HIV-1 infection. BMC Infect Dis. 2022;22(1):17. Beemer A, et al. Self- and Proxy-Completion of Quality of Life Assessment in Dementia Care: A Review of Reviews. J Nurs Meas; 2024. Justice AC, et al. Development and validation of a self-completed HIV symptom index. J Clin Epidemiol. 2001;54(Suppl 1):S77–90. Xiong N, et al. Validation of patient health questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: a multicenter cross-sectional study. J Affect Disord. 2015;174:636–43. Sun XY, et al. [Reliability and validity of depression scales of Chinese version: a systematic review]. Zhonghua Liu Xing Bing Xue Za Zhi. 2017;38(1):110–6. Weng G, et al. Comparing EQ-5D-3L and EQ-5D-5L in measuring the HRQoL burden of 4 health conditions in China. Eur J Health Econ. 2023;24(2):197–207. Luo N, et al. Estimating an EQ-5D-5L Value Set for China. Value Health. 2017;20(4):662–9. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30. Paredes JL et al. Depression is associated with poor self-reported adherence to antiretroviral therapy among people living with HIV attending an HIV clinic in the UK: results from a cross-sectional study. AIDS Care, 2024: p. 1–8. Tan T, et al. Depression and Associated Factors Among Men Living with HIV/AIDS Aged 50 Years and Over in Chongqing, China. J Multidiscip Healthc. 2022;15:2033–40. Huang X, et al. The Double Burdens of Mental Health Among AIDS Patients With Fully Successful Immune Restoration: A Cross-Sectional Study of Anxiety and Depression in China. Front Psychiatry. 2018;9:384. Dong N, et al. Unmet needs of symptom management and associated factors among the HIV-positive population in Shanghai, China: A cross-sectional study. Appl Nurs Res. 2020;54:151283. Maulsby CH, et al. A Scoping Review of Employment and HIV. AIDS Behav. 2020;24(10):2942–55. Sheehan DM, et al. Individual and Neighborhood Determinants of Late HIV Diagnosis Among Latinos, Florida, 2007–2011. J Immigr Minor Health. 2017;19(4):825–34. d'Arminio Monforte A, et al. Late presenters in new HIV diagnoses from an Italian cohort of HIV-infected patients: prevalence and clinical outcome. Antivir Ther. 2011;16(7):1103–12. Shacham E, et al. Are neighborhood conditions associated with HIV management? HIV Med. 2013;14(10):624–32. Nijhawan AE, et al. Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care. AIDS Patient Care STDS. 2017;31(5):213–21. Nachega JB, et al. Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis. Bull World Health Organ. 2015;93(1):29–41. Xie M, et al. Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study. BMC Geriatr. 2022;22(1):728. Njajula M, Okafor UB. Depressive Symptoms and Associated Factors Among People Living with HIV/AIDS and Undergoing Antiretroviral Therapy: A Cross-Sectional Study in the Amathole District, South Africa. J Multidiscip Healthc. 2023;16:3777–87. Gebru T, et al. Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia. Sci Rep. 2024;14(1):1642. Shrestha S et al. Depressive Symptoms among People Living with HIV Attending ART Centers of Lumbini Province, Nepal: A Cross-Sectional Study. AIDS Res Treat, 2023. 2023: p. 3526208. Xiao J, et al. Anxiety, depression, and sleep disturbances among people on long-term efavirenz-based treatment for HIV: a cross-sectional study in Beijing, China. BMC Psychiatry. 2022;22(1):710. Cameron IM, et al. Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract. 2008;58(546):32–6. Xia H, et al. Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV. Chin Med J (Engl). 2021;134(23):2850–6. Li Y, et al. Neuropsychological changes in efavirenz switch regimens. Aids. 2019;33(8):1307–14. Vera JH et al. Improved Central Nervous System Symptoms in People with HIV without Objective Neuropsychiatric Complaints Switching from Efavirenz to Rilpivirine Containing cART. Brain Sci, 2019. 9(8). Tiraboschi J, et al. Short Communication: The Impact of Switching from Atripla to Darunavir/Ritonavir Monotherapy on Neurocognition, Quality of Life, and Sleep: Results from a Randomized Controlled Study. AIDS Res Hum Retroviruses. 2016;32(12):1198–201. Apostolova N, et al. Efavirenz: What is known about the cellular mechanisms responsible for its adverse effects. Eur J Pharmacol. 2017;812:163–73. Apostolova N, et al. Efavirenz and the CNS: what we already know and questions that need to be answered. J Antimicrob Chemother. 2015;70(10):2693–708. Tables Table 1 Demographic and clinical characteristics of HIV patients Variable N (%)/Mean (SD) Age (yrs) 31.2 (7.5) Gender Male 141 (98.6) Education Middle/High school 36 (25.2) University 107 (74.8) Work status With formal work 77 (53.8) Without formal work/student 66 (46.2) Comorbidity 24 (16.8) Current treatment BIC/FTC/TAF 122 (85.3) DTG/3TC 21 (14.7) Treatment history Naive 52 (36.4) Experienced 91 (63.6) Treatment switch due to safety reason 61 (42.7) CD4 cell counts (cells/µL) 0-200 18 (12.6) 201–300 50 (35.7) > 500 71 (49.7) Viral load (copies/ml) 0-200 123 (86.0) > 200 15 (10.5) Length of disease (years) 3.1 (3.1) Length from HIV diagnosis to ART initiation (days) ≤ 30 79 (55.2) 30–90 40 (28.0) ≥ 90 24 (16.8) Table 2 The total score/health utility and symptom/domain score of HIV-SI, PHQ-9 and EQ-5D-5L of HIV patient N(%)/Mean (SD) Naive Experienced P-value HIV-SI total score 26.7 (14.4) 22.5 (14.0) 29.0 (14.1) 0.009 Bothersome in physical symptoms Fatigue/loss of energy 94 (65.7) 30 (58.8) 64 (69.6) 0.195 Fevers/chills/sweats 59 (41.3) 19 (37.3) 40 (43.5) 0.469 Dizzy/lightheadedness 62 (43.4) 17 (33.3) 45 (48.9) 0.072 Pain/numbness/tingling in hands/feet 53 (37.1) 12 (23.5) 41 (44.6) 0.013 Nausea/vomiting 86 (60.1) 21 (41.2) 65 (70.7) 0.001 Diarrhea/loose bowels 55 (38.5) 15 (29.4) 40 (43.5) 0.098 Coughing/trouble breathing 75 (52.4) 22 (43.1) 53 (57.6) 0.097 Headaches 82 (57.3) 20 (39.2) 62 (67.4) 0.001 Loss of appetite 85 (59.4) 20 (39.2) 65 (70.7) < 0.001 Bloating/pain/gas in stomach 91 (63.6) 26 (51.0) 65 (70.7) 0.019 Muscle aches/joint pain 65 (45.5) 23 (45.1) 42 (45.7) 0.949 Problems with sex 58 (40.6) 19 (37.3) 39 (42.4) 0.549 Cognitive & psychological symptoms Trouble remembering 54 (37.8) 13 (25.5) 41 (44.6) 0.024 Sad/down/depressed 56 (39.2) 17 (33.3) 39 (42.4) 0.288 Nervous/anxious 60 (42.0) 16 (31.4) 44 (47.8) 0.056 Difficulty sleeping 70 (49.0) 20 (39.2) 50 (54.3) 0.083 Body image symptoms Skin problems/rash/itching 72 (50.3) 20 (39.2) 52 (56.5) 0.047 Changes in body composition/weight gain 72 (50.3) 18 (35.3) 54 (58.7) 0.047 Weight loss/wasting 65 (45.5) 21 (41.2) 44 (47.8) 0.444 Hair loss/changes 72 (50.3) 20 (39.2) 52 (56.5) 0.047 PHQ-9 total score 7.4 (1.0) 6.1 (4.9) 8.0 (4.9) 0.028 Absence of depression 46 (32.2) 22 (44.9) 24 (26.7) 0.029 Presence of depression 93 (65.0) 27 (55.1) 66 (73.3) EQ-5D utility score 0.95 (0.12) 0.94 (0.16) 0.95 (0.09) 0.817 Reporting problems in each domain Mobility 4 (7.8) 2 (2.2) 6 (4.2) 0.105 Self-care 2 (3.9) 2 (2.2) 4 (2.8) 0.544 Usual activity 3 (5.9) 3 (3.3) 6 (4.2) 0.454 Pain/discomfort 5 (9.8) 15 (16.3) 20 (14) 0.283 Anxiety/depression 15 (29.4) 44 (47.8) 59 (41.3) 0.032 Table 3 The effects of factors on each HRQoL measure in the generalized liner model Beta* Standard error P-value^ HIV-SI score Age (years old) < 30 Ref ≥ 30 6.06 2.37 0.010 Work status With formal work Ref No formal work 6.86 2.22 0.002 Treatment history No treatment switch Ref Treatment switch due to safety reason 6.31 3.12 0.043 PHQ-9 score Age (years old) < 30 Ref ≥ 30 2.15 0.81 0.008 Work status With formal work Ref No formal work 2.69 0.76 500 Ref 0-200 3.07 1.20 0.011 Treatment history No treatment switch Ref Treatment switch due to safety reason 2.25 1.06 0.034 EQ-5D-5L utility Age < 30 Ref ≥ 30 -0.05 0.02 0.012 Education University and above Ref Middle/High school -0.06 0.02 0.006 Work status With formal work Ref No formal work -0.05 0.02 0.007 Comorbidity Without comorbidity Ref With comorbidity -0.05 0.02 0.024 Length from HIV diagnosis to ART initiation (days) ≤ 30 Ref 30–90 -0.05 0.02 0.029 ≥ 90 -0.06 0.03 0.030 *Age group, education, work status, comorbidity status, viral load, CD4 cell counts, Length of HIV diagnosis to ART initiation, length of disease, treatment history, and current treatment regimen were adjusted as the covariates in the model. ^ The covariates with p-value < 0.05 were shown in the table. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4635838","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319643617,"identity":"22ba2539-3cde-4bdd-9b4d-fe48ab4b0e6f","order_by":0,"name":"Wei Tang","email":"","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Tang","suffix":""},{"id":319643618,"identity":"881b2a1c-8bd1-48be-90e7-576ba387d406","order_by":1,"name":"Yaxiong Huang","email":"","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":false,"prefix":"","firstName":"Yaxiong","middleName":"","lastName":"Huang","suffix":""},{"id":319643619,"identity":"aa03d0d8-6772-4bee-b9ab-81fdea07234e","order_by":2,"name":"Hui Qi","email":"","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Qi","suffix":""},{"id":319643621,"identity":"1b4373ed-1cef-4ed0-9c94-3b4bf9da789b","order_by":3,"name":"Zhong Chen","email":"","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":false,"prefix":"","firstName":"Zhong","middleName":"","lastName":"Chen","suffix":""},{"id":319643623,"identity":"6f462919-ab7f-4643-b1d6-d5f75e9243a7","order_by":4,"name":"Fang Zheng","email":"","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Zheng","suffix":""},{"id":319643624,"identity":"beeba9f1-0377-49d1-854b-04b3f6f5fb26","order_by":5,"name":"Guoqiang Zhou","email":"","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":false,"prefix":"","firstName":"Guoqiang","middleName":"","lastName":"Zhou","suffix":""},{"id":319643625,"identity":"21d26cb5-9a63-4e9e-811c-706c86faafcf","order_by":6,"name":"Gang Xiao","email":"","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":false,"prefix":"","firstName":"Gang","middleName":"","lastName":"Xiao","suffix":""},{"id":319643626,"identity":"bfd01e4b-be70-4d66-8321-ae6680ba4d6f","order_by":7,"name":"Jing Cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYFACxgYgwSbHxt58gFgtzGAtxnw8xxKI1cIO0sKQOE8iR4E4Dfz9Bxs//KjgS29jyGFg+FGxjbAWiRuJzZI9Z9hy2xjOHmDsOXObsBYDCcY2Bt42oBbGvgRmxjZitPAfbGP828aWzsbMY0CkFobENmagLQlsbMRqAflFWuYMm2EbD1vCQaL8wt9//OHHNxXH5OXnPz744EcFEVqg4BiYPEC0eiCoIUXxKBgFo2AUjDQAAJELN4FBLlpqAAAAAElFTkSuQmCC","orcid":"","institution":"the First Hospital of Changsha","correspondingAuthor":true,"prefix":"","firstName":"Jing","middleName":"","lastName":"Cao","suffix":""}],"badges":[],"createdAt":"2024-06-25 10:52:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4635838/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4635838/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102964625,"identity":"faa771cc-bc98-488b-ab92-77aa506c9cc2","added_by":"auto","created_at":"2026-02-19 04:23:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":915229,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4635838/v1/7791aae3-c82a-4d7b-98dc-d6cf04694792.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Measuring the health-related quality of life in HIV patients with integrase strand transfer inhibitor-based regimens in China","fulltext":[{"header":"Background","content":"\u003cp\u003eHIV imposes a great disease burden in China. As reported by China Center for Disease Control and Prevention (CDC), around 1.22\u0026nbsp;million patients living with HIV/AIDS, with accumulative death of 418 thousand cases by end of 2022[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. An increasing trend of the HIV/AIDS incidence was observed from 2010 to 2022, especially in the age group\u0026thinsp;\u0026ge;\u0026thinsp;50 years, highlighting the ongoing challenges of HIV/AIDS control in China[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Antiretroviral therapy (ART) has been widely used in HIV treatment to reduce the mortality and morbidity of HIV patients in China. According to the Chinese Guidelines for Diagnosis and Treatment of Human Immuodeficiency Virus Infection/Acquired Immunoeficiency Syndrome (2021 Edition), the regimen containing two nucleoside reverse transcriptase inhibitors (NRTIs) plus a third drug (a non-nucleoside reverse transcriptase inhibitor [NNRTI], or a boosted protease inhibitor [PI] or an integrase strand transfer inhibitor [INSTI]) are recommended[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Specifically, bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/c/FTC/TAF) and dolutegravir/lamivudine (DTG/3TC) are the INSTI-based single-table regimens (STRs) included in the National Reimbursement Drug List (NRDL) in China[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. With the reimbursement from government, patients\u0026rsquo; out-of-pocket payment is reduced significantly and subsequently the INSTI-based STRs could be afforded and used by more patients.\u003c/p\u003e \u003cp\u003eThough with innovative ART, HIV patients suffer from depression, anxiety, financial stress and HIV-related discrimination, which greatly reduce their health-related quality of life (HRQoL). The HRQoL is evaluated through the patient-reported outcomes. Various patient-reported outcome (PRO) measures could be utilized to support HIV management by capturing patients\u0026rsquo; ART experience accurately, evaluating and differentiating treatment strategy and predict clinical outcomes[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Previous studies have evaluated and found the low HRQoL and associated factors in HIV patients [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Nevertheless, majority of the studies were conducted before BIC/FTC/TAF or DTG/3TC included in NRDL and have no restriction on the regimen received. A single-center, prospective study was conducted to evaluate the PRO in HIV patients with BIC/FTC/TAF in southwest China, while several limitations constrain the generalizability of the study findings including lack of HIV patients with other INSTI-based regimens, without multivariate analysis of PRO data and no EQ-5D utility score generated and analyzed in the study[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Considering the better efficacy, safety and persistence profile of INSTI-based STRs, the aim of the study is to measure the HRQoL of HIV patients with INSTI-based STRs in China[\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003eThis is a cross-sectional survey of HIV patients in the Department of Infection in First Hospital of Changsha to evaluate the health-related quality of life of patients with INSTI-based regimens. The hospital is a tier 3A hospital in Hunan Province, covering the majority of the treatment of HIV/AIDS patients in the province. This study followed the principles of Declaration of Helsinki and the ethical approval was obtained from the Central Institutional Review Board of the First Hospital of Changsha in Hunan province.\u003c/p\u003e \u003cp\u003eStudy population\u003c/p\u003e \u003cp\u003eAdult patients diagnosed with HIV-1 infection between January 1st, 2021 and July 31st, 2022, with the prescription of BIC/FTC/3TC or DTG/3TC as the current treatment were included in the study. Patients with pregnancy or severe infections, or unable to complete the HRQoL questionnaires were excluded. The patients\u0026rsquo; responses were collected through a digital platform with the access through wechat, the widely used social media platform in China. Patients answered each question of the PRO measures by themselves to avoid proxy bias[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. All patients participated in the study signed the informed consent form.\u003c/p\u003e \u003cp\u003eHRQoL measures\u003c/p\u003e \u003cp\u003ePatients\u0026rsquo; HRQoL were measured by three questionnaires, including HIV-symptom index (HIV-SI) questionnaire, Patient Health Questionnaire-9 (PHQ-9) and the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L). As a validated PRO instrument, HIV Symptom Index (HIV-SI) evaluates the impact of 20 symptoms associated with HIV infection or treatment[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Participants rated their experiences for each of the 20 symptoms with a 5-poin scale from 0 (I don\u0026rsquo;t have this symptom) to 4 (I was bothered a lot). The 20 symptoms included fatigue/energy loss, insomnia, tension/anxiety, diarrhea, changes in body composition, feeling sad/depressed, abdominal distension/stomachache/flatulence, muscle soreness/joint pain, decreased sexual ability, poor memory, headache, hand/foot pain/numbness/tingling, skin problems/rash/itching, cough/difficulty breathing, fever/chills/sweating, dizziness, weight loss/weight gain, nausea/vomiting, alopecia, and loss of appetite/loss of food taste. The sum of each symptom\u0026rsquo;s score was calculated and a higher total score indicated a higher symptom burden. The Chinese version of HIV-SI has been applied in previous HIV study[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe PHQ-9 assessed the participant\u0026rsquo;s depressive status from 9 symptoms with a 4-point scale from 0 (not any) to 3 (almost every day). The 9 symptoms included anhedonia, depressed emotion, sleep trouble, fatigue, changes in appetite, low self-esteem, concentration troubles, psychomotor problems, and suicidal thoughts. The sum of each symptom\u0026rsquo;s score was calculated and a higher score indicated a higher depressive status. The presence of depression was classified with a cut-off value of 5[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The PHQ-9 had been proven to be a reliable and valid tool to detect depression in Chinese patients[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEQ-5D-5L is a widely used preference-based instrument with a descriptive of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L is developed from the widely used EQ-5D-3L with an expansion of 3 levels (no, moderate and extreme problems) to 5 levels (no, slight, moderate, severe, and extreme problems) in each dimension. Compared with EQ-5D-3L, the EQ-5D-5L were shown to have better efficiency in Chinese HIV patients[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The health utility score was calculated with a published national value set in Chinese population[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were reported with mean and standard deviation (SD). Categorical variables were reported with count (frequency) and percentage. T-test and chi-square test were used in between group comparisons for continuous variables and categorical variables, respectively. Generalized linear regression was used to estimate the effects of covariates on each HRQoL measure. Age group, education, work status, comorbidity status, viral load, CD4 cell counts, Length of HIV diagnosis to ART initiation, length of disease, treatment history, and current treatment regimen were included as the covariates in the model. All statistical analysis were performed with SPSS\u0026reg; version 26.0 (IBM Corp., Armonk, NY). The statistical significance of all tests was assessed with a significance level of 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe patient demographic and clinical characteristics are shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 143 HIV patients with HRQoL data available were included in the study. The mean (SD) age were 31.2 (7.5) years old, with the majority of patients as male (98.6%), with university education (74.8%) and formal work (53.8%). 16.8% of patients were with comorbidity and 85.3% of patients were with BIC/FTC/TAF as the current treatment regimen (85.3%). 63.6% of patients were treatment experienced, among which 42.7% had the treatment switch due to safety reason. 49.7% and 86.0% of patients were with CD4 cell counts\u0026thinsp;\u0026gt;\u0026thinsp;500 cells/\u0026micro;L and viral suppressed (defined as viral load\u0026thinsp;\u0026le;\u0026thinsp;200 copies/ml), respectively. The mean (SD) length of disease were 3.1 (3.1) years and about half patients (55.2%) initiated the ART within 30 days from HIV diagnosis.\u003c/p\u003e \u003cp\u003eThe total score/health utility and symptom/domain score of HIV-SI, PHQ-9 and EQ-5D-5L are shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean (SD) of HIV-SI total score, PHQ-9 total score and EQ-5D utility score was 26.67 (14.40), 7.35 (0.95) and 0.95 (0.12), respectively. In terms of HIV-SI, more than 50% of patients reported bothersome in fatigue/loss of energy (65.7%), nausea/vomiting (60.1%), coughing/trouble breathing (52.4%), headaches (57.3%), loss of appetite (59.4%), bloating/pain/gas in stomach (63.6%), skin problems/rash/itching (50.3%), changes in body composition/weight gain (50.3%), and hair loss/changes (50.3%). Compared with treatment-na\u0026iuml;ve patients, treatment-experienced patients reported significantly higher proportion with bothersome in pain/numbness/tingling in hands/feet, nausea/vomiting, headache, loss of appetite, bloating/pain/gas in stomach, trouble remembering, skin problems/rash/itching, changes in body composition/weight gain, and hair loss/changes (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). According to the responses to PHQ-9 and EQ-5D-5L, 65.0% of patients reported the presence of depression, while 29.4% of patients reported problems with anxiety/depression among the EQ-5D domains. Compared with treatment-naive patients, treatment-experienced patients reported significantly higher score/proportion of PHQ-9 total score, presence of depression and problems in anxiety/depression (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe generalized linear model of health utility, PHD-9 and HIV-SI total score are shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Patients with older age, (HIV-SI: beta\u0026thinsp;=\u0026thinsp;5.86, standard error [SE]\u0026thinsp;=\u0026thinsp;2.40, p\u0026thinsp;=\u0026thinsp;0.015; PHQ-9: beta\u0026thinsp;=\u0026thinsp;2.14, SE\u0026thinsp;=\u0026thinsp;0.81, p\u0026thinsp;=\u0026thinsp;0.008), without formal work (HIV-SI: beta\u0026thinsp;=\u0026thinsp;6.98, SE\u0026thinsp;=\u0026thinsp;2.25, p\u0026thinsp;=\u0026thinsp;0.002; PHQ-9: beta\u0026thinsp;=\u0026thinsp;2.69, SE\u0026thinsp;=\u0026thinsp;0.76, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and having treatment switch due to safety reason (HIV-SI: beta\u0026thinsp;=\u0026thinsp;6.53, SE\u0026thinsp;=\u0026thinsp;3.16, p\u0026thinsp;=\u0026thinsp;0.039; PHD-9: beta\u0026thinsp;=\u0026thinsp;2.26, SE\u0026thinsp;=\u0026thinsp;1.06, p\u0026thinsp;=\u0026thinsp;0.032) had significantly higher HIV symptoms and worse depression status, respectively. Lower CD4 cell counts was also associated with worse depression status (PHQ-9: beta\u0026thinsp;=\u0026thinsp;3.16, SE\u0026thinsp;=\u0026thinsp;1.18, p\u0026thinsp;=\u0026thinsp;0.007). Apart from older age (beta=-0.05, SE\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;=\u0026thinsp;0.013), no formal work (beta=-0.05, SE\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;=\u0026thinsp;0.008), with comorbidity (beta=-0.06, SE\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;=\u0026thinsp;0.021), lower education level (beta=-0.06, SE\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;=\u0026thinsp;0.006) and longer ART initiation time (30\u0026ndash;90 days: beta=-0.05, SE\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;=\u0026thinsp;0.025; \u0026gt;90 days: beta=-0.06, SE\u0026thinsp;=\u0026thinsp;0.03, p\u0026thinsp;=\u0026thinsp;0.030) were also found to be associated with worse utility score significantly.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first study to explore the HRQoL in HIV patients with INSTI-based regimens in China. The prevalence of depression measured by PHQ-9 was reported as 65.0% in our study. Considering depression impairing patients\u0026rsquo; social function and decreasing medication adherence, screening and management of depression might good to be integrated into the routine HIV care[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, The association between employment and depression shown in our study was consistent with previous studies in China [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Due to poor health condition, discrimination and stigma, HIV faced the great challenge of unemployment. Nevertheless, the employment status has been shown to play a critical role in the timely HIV diagnosis, linkage to HIV care and HIV medication adherence [\u003cspan additionalcitationids=\"CR27 CR28 CR29 CR30\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Considering the lower employment rate of HIV patients in China compared with western countries, the needs for social support or patient-assistant program for HIV patients are highlighted[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study results showed patients with lower CD4 cell counts had significantly more problems with HIV symptoms and worse depression status, which was consistent with previous studies[\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Nevertheless, the finding is different from that of several China studies reporting no association between CD4 cell counts and depression[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. One possible reason is the different depression measures used in our study (PHQ-9) and previous studies (Hospital Anxiety and Depression Scale [HADS]). Both PHD-9 and HADS depression subscale are reliable and valid, while they differed significantly in categorizing depression severity with PHQ-9 categorizing more patients with moderate-to-severe depression[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Therefore, the depression status difference among CD4 cell count level might be better captured. Another possible reason is the previous studies conducted before BIC/FTC/TAF or DTG/3TC included in NRDL list and most of the treatment regimens patients received were not INSTI-based regimens. For example, all patients were with EFV-based regimens in the study published in 2022[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Compared with EFV-based regimens, BIC/FTC/TAF had a significantly higher CD4 cell counts increase, indicating a better immune reconstitution in Chinese HIV patients. As a result, the change in the immune function might be more obvious in the patients with INSTI-based regimens in our study, compared with those in previous studies. Nevertheless, given the small number of publications, further studies might be needed for exploration.\u003c/p\u003e \u003cp\u003eThe association between treatment switch due to safety reason and depression highlighted the importance for initiation of INSTI-based regimens. Our study results showed the quality of life of these patients after switch still worse than those with the initiation of INSTI-based regimen, which is supported by the limited change of depression severity after EFV switch shown in previous studies[\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Though EFV-induced central nervous system (CNS) adverse events usually appear early and might diminish within the 1st month of treatment, the adverse events persist in a significant proportion of EFV patients[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These findings indicated the necessity to initiate INSTI-based regimen with better safety profile rather than resolving the depression problem by treatment switch ineffectively. Though previous studies have shown the ART side effects are associated with poor quality of life, generic EFV and generic LPV-based regimens are recommended as the first-line treatment regimens and widely used in clinical practice. Considering 40%-60% of HIV patients treated with EFV suffering from the related CNS adverse events, the ART imitation with EFV might not be an optimal choice[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are some limitations in the study. Firstly, the study findings only represented the HRQoL of HIV patients in the hospital in Hunan province and might not be generalized to PLHW in other cities/provinces in China. Secondly, due to the lack of longitudinal data, the association between demographic, clinical characteristics and PRO measures rather than the causal effects were assessed in the study. Further analysis might be conducted with longitudinal data in future study. Thirdly, there was a limited number of female HIV patients in our study, which might constrain the generalizability of the study findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, HIV patients suffer from HIV symptoms and depression, which greatly deteriorate their HRQoL. Considering the aging population and lower employment rate, the needs for social support or patient-assistant program for HIV patients are highlighted. Meanwhile, the early initiation of INSTI-based regimens is necessary to avoid the HRQoL loss due to safety reasons.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"533\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull name\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eantiretroviral therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eBIC/TAF/TAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003ebictegravir/emtricitabine/tenofovir\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eCenter for Disease Control and Prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eCNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003ecentral nervous system\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eDTG/3TC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003edolutegravir/lamivudine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eEQ-5D-5L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003ethe five-level version of the EuroQol five-dimensional questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eEFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eefavirenz\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eEVG/c/FTC/TAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eelvitegravir/cobicistat/emtricitabine/tenofovir alafenamide\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eHADS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eHospital Anxiety and Depression Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eHIV-SI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eHIV-symptom index (HIV-SI) questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eHRQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003ehealth-related quality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eINSTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eintegrase strand transfer inhibitor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003ePatient Health Questionnaire‐9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eNRDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eThe National Reimbursement Drug List\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eNRTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003enucleoside reverse transcriptase inhibitors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eNNRTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003enon-nucleoside reverse transcriptase inhibitor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003ePI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003eprotease inhibitor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003estandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003estandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.765478424015008%\"\u003e\n \u003cp\u003eSTR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.23452157598499%\"\u003e\n \u003cp\u003esingle-table regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in accordance with the Declaration of Helsinki. The ethics committee of the First Hospital of Changsha approved the study protocol. The data used in this study was anonymized before its use. The need for informed consent was waived by the ethics committee/Institutional Review Board of the First Hospital of Changsha because of the retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No individual person\u0026rsquo;s data was shown separately and all data are presented as a whole.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author on reasonable request. Participant data without names and identifiers will be made available after approval from the corresponding author. After publication of study findings, the data will be available for others to request. The research team will provide an email address for communication once the data are approved to be shared with others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by grants of the National Major Infectious Prevention and Treatment Program in the 13th Five-Year Plan (2018zx10302104-001) and Special Foundation for Innovation Development in Hunan Province (2020SK21362). The funding bodies had no role in the design of the study, data collection, data analysis and interpretation, and in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTW, HY, QH, CZ, ZF and CJ were responsible for the study concept and design, data collection, data analysis and interpretation, and manuscript drafting. ZG, XG and CJ were responsible for the critical revision of manuscript and final approval for publication. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our appreciation for all the patients included in this study as well as their families.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e\u003cem\u003eHIV infection, mortality rates in China stand at low level globally. The State Council, the People's Republic of China.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://english.www.gov.cn/news/202311/30/content_WS65686e0fc6d0868f4e8e1c4d.\u003c/span\u003e\u003cspan address=\"https://english.www.gov.cn/news/202311/30/content_WS65686e0fc6d0868f4e8e1c4d.\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cem\u003ehtml Accessed on May 28th\u003c/em\u003e, 2024. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHou Y et al. \u003cem\u003eComparative Analysis of Epidemiological Features of HIV/AIDS Cases Aged Over and Under 50 Years Old - China, 2010\u0026ndash;2022.\u003c/em\u003e China CDC Wkly, 2023. 5(48): pp. 1079\u0026ndash;1083.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e[Chinese guidelines for diagnosis and treatment of HIV/AIDS (2021 edition)]. Zhonghua nei ke za zhi, 2021. 60(12): p. 1106\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eThe National Healthcare Security Administration. A renewed catalog of drugs covered by its national medical insurance system.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.nhsa.gov.cn/art/2023/12/13/art_53_11674.html\u003c/span\u003e\u003cspan address=\"http://www.nhsa.gov.cn/art/2023/12/13/art_53_11674.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed on May 24th, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKall M, et al. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV. 2020;7(1):e59\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie M, et al. Effects of Perceived Social Support on Health-Related Quality of Life in Asymptomatic and Symptomatic People Living with HIV in China: A Cross-Sectional Study. Curr HIV Res. 2023;21(1):63\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong H, et al. Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study. Front Public Health. 2023;11:1133657.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, et al. The role of personality, social economic and prevention strategy effects on health-related quality of life among people living with HIV/AIDS. Infect Dis Poverty. 2021;10(1):104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu K, et al. Sexual orientation and quality of life of people living with HIV/AIDS in China: evidence from an institutional-based cross-sectional study. Qual Life Res. 2022;31(1):125\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKong L, et al. Clinical efficacy, safety, and subjective experience based on ePRO in HIV-infected individuals administered Bictegravir/Emtricitabine/Tenofovir Alafenamide in southwest China. Immun Inflamm Dis. 2023;11(8):e974.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJing C, et al. Treatment persistence of bictegravir/emtricitabine/tenofovir alafenamide and efavirenz\u0026thinsp;+\u0026thinsp;lamivudine\u0026thinsp;+\u0026thinsp;tenofovir disoproxil among HIV-1 patients newly starting treatment in Hunan Province in China. BMC Infect Dis. 2023;23(1):396.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang R, et al. Rapid Initiation of Antiretroviral Therapy with Coformulated Bictegravir, Emtricitabine, Tenofovir Alafenamide Versus Efavirenz, Lamivudine and Tenofovir Disoproxil Fumarate in HIV-positive Men Who Have Sex with Men in China: Week 48 Results of the Multicenter, Randomized Clinical Trial. Clin Infect Dis; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorward J, et al. Implementation and outcomes of dolutegravir-based first-line antiretroviral therapy for people with HIV in South Africa: a retrospective cohort study. Lancet HIV. 2023;10(5):e284\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng L, et al. Dolutegravir plus lamivudine versus efavirenz plus tenofovir disoproxil fumarate and lamivudine in antiretroviral-naive adults with HIV-1 infection. BMC Infect Dis. 2022;22(1):17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeemer A, et al. Self- and Proxy-Completion of Quality of Life Assessment in Dementia Care: A Review of Reviews. J Nurs Meas; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJustice AC, et al. Development and validation of a self-completed HIV symptom index. J Clin Epidemiol. 2001;54(Suppl 1):S77\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong N, et al. Validation of patient health questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: a multicenter cross-sectional study. J Affect Disord. 2015;174:636\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun XY, et al. [Reliability and validity of depression scales of Chinese version: a systematic review]. Zhonghua Liu Xing Bing Xue Za Zhi. 2017;38(1):110\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeng G, et al. Comparing EQ-5D-3L and EQ-5D-5L in measuring the HRQoL burden of 4 health conditions in China. Eur J Health Econ. 2023;24(2):197\u0026ndash;207.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo N, et al. Estimating an EQ-5D-5L Value Set for China. Value Health. 2017;20(4):662\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCiesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParedes JL et al. Depression is associated with poor self-reported adherence to antiretroviral therapy among people living with HIV attending an HIV clinic in the UK: results from a cross-sectional study. AIDS Care, 2024: p. 1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan T, et al. Depression and Associated Factors Among Men Living with HIV/AIDS Aged 50 Years and Over in Chongqing, China. J Multidiscip Healthc. 2022;15:2033\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang X, et al. The Double Burdens of Mental Health Among AIDS Patients With Fully Successful Immune Restoration: A Cross-Sectional Study of Anxiety and Depression in China. Front Psychiatry. 2018;9:384.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong N, et al. Unmet needs of symptom management and associated factors among the HIV-positive population in Shanghai, China: A cross-sectional study. Appl Nurs Res. 2020;54:151283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaulsby CH, et al. A Scoping Review of Employment and HIV. AIDS Behav. 2020;24(10):2942\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheehan DM, et al. Individual and Neighborhood Determinants of Late HIV Diagnosis Among Latinos, Florida, 2007\u0026ndash;2011. J Immigr Minor Health. 2017;19(4):825\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ed'Arminio Monforte A, et al. Late presenters in new HIV diagnoses from an Italian cohort of HIV-infected patients: prevalence and clinical outcome. Antivir Ther. 2011;16(7):1103\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShacham E, et al. Are neighborhood conditions associated with HIV management? HIV Med. 2013;14(10):624\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNijhawan AE, et al. Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care. AIDS Patient Care STDS. 2017;31(5):213\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNachega JB, et al. Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis. Bull World Health Organ. 2015;93(1):29\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie M, et al. Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study. BMC Geriatr. 2022;22(1):728.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNjajula M, Okafor UB. Depressive Symptoms and Associated Factors Among People Living with HIV/AIDS and Undergoing Antiretroviral Therapy: A Cross-Sectional Study in the Amathole District, South Africa. J Multidiscip Healthc. 2023;16:3777\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebru T, et al. Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia. Sci Rep. 2024;14(1):1642.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha S et al. \u003cem\u003eDepressive Symptoms among People Living with HIV Attending ART Centers of Lumbini Province, Nepal: A Cross-Sectional Study.\u003c/em\u003e AIDS Res Treat, 2023. 2023: p. 3526208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiao J, et al. Anxiety, depression, and sleep disturbances among people on long-term efavirenz-based treatment for HIV: a cross-sectional study in Beijing, China. BMC Psychiatry. 2022;22(1):710.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCameron IM, et al. Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract. 2008;58(546):32\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXia H, et al. Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV. Chin Med J (Engl). 2021;134(23):2850\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Y, et al. Neuropsychological changes in efavirenz switch regimens. Aids. 2019;33(8):1307\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVera JH et al. Improved Central Nervous System Symptoms in People with HIV without Objective Neuropsychiatric Complaints Switching from Efavirenz to Rilpivirine Containing cART. Brain Sci, 2019. 9(8).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTiraboschi J, et al. Short Communication: The Impact of Switching from Atripla to Darunavir/Ritonavir Monotherapy on Neurocognition, Quality of Life, and Sleep: Results from a Randomized Controlled Study. AIDS Res Hum Retroviruses. 2016;32(12):1198\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApostolova N, et al. Efavirenz: What is known about the cellular mechanisms responsible for its adverse effects. Eur J Pharmacol. 2017;812:163\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApostolova N, et al. Efavirenz and the CNS: what we already know and questions that need to be answered. J Antimicrob Chemother. 2015;70(10):2693\u0026ndash;708.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic and clinical characteristics of HIV patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN (%)/Mean (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAge (yrs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.2 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141 (98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMiddle/High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107 (74.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eWork status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWith formal work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWithout formal work/student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCurrent treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBIC/FTC/TAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e122 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDTG/3TC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTreatment history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNaive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eExperienced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment switch due to safety reason\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCD4 cell counts (cells/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0-200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e201\u0026ndash;300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71 (49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eViral load (copies/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0-200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eLength of disease (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eLength from HIV diagnosis to ART initiation (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e30\u0026ndash;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe total score/health utility and symptom/domain score of HIV-SI, PHQ-9 and EQ-5D-5L of HIV patient\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN(%)/Mean (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNaive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eExperienced\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV-SI total score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.7 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e22.5 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e29.0 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBothersome in physical symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFatigue/loss of energy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94 (65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e30 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e64 (69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFevers/chills/sweats\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e19 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e40 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDizzy/lightheadedness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e17 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e45 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain/numbness/tingling in hands/feet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e12 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e41 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNausea/vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 (60.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e21 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e65 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiarrhea/loose bowels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e15 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e40 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoughing/trouble breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e22 (43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e53 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeadaches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e62 (67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLoss of appetite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e65 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBloating/pain/gas in stomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e26 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e65 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuscle aches/joint pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e23 (45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e42 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblems with sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e19 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e39 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive \u0026amp; psychological symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrouble remembering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e13 (25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e41 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSad/down/depressed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e17 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e39 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNervous/anxious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e16 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e44 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifficulty sleeping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e50 (54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody image symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkin problems/rash/itching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e52 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChanges in body composition/weight gain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e18 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e54 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight loss/wasting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e21 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e44 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHair loss/changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e52 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003ePHQ-9 total score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.4 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6.1 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e8.0 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAbsence of depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e22 (44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e24 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePresence of depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e27 (55.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e66 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eEQ-5D utility score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.94 (0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.95 (0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eReporting problems in each domain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsual activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain/discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e15 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnxiety/depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e44 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e59 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe effects of factors on each HRQoL measure in the generalized liner model\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBeta*\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard error\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value^\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV-SI score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge (years old)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWork status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith formal work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTreatment history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo treatment switch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment switch due to safety reason\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003ePHQ-9 score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge (years old)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWork status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith formal work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCD4 cell counts (cells/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0-200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTreatment history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo treatment switch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment switch due to safety reason\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eEQ-5D-5L utility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle/High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWork status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith formal work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eLength from HIV diagnosis to ART initiation (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e*Age group, education, work status, comorbidity status, viral load, CD4 cell counts, Length of HIV diagnosis to ART initiation, length of disease, treatment history, and current treatment regimen were adjusted as the covariates in the model.\u003c/p\u003e\n\u003cp\u003e^ The covariates with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were shown in the table.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV, INSTI-based STRs, HRQoL, depression, China","lastPublishedDoi":"10.21203/rs.3.rs-4635838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4635838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eWith bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), and dolutegravir/lamivudine (DTG/3TC) included in the national drug reimbursement list, the integrase strand transfer inhibitor (INSTI)-based regimens could be afforded and used by more patients. Majority of previous health-related quality of life (HRQoL) studies were conducted before INSTI-based regimens reimbursed and have no restriction on the regimens received. The aim of the study is to measure the HRQoL of HIV patients with INSTI-based regimens in China.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eA cross-sectional survey of HIV patients conducted in the First Hospital of Changsha. Adult patients diagnosed with HIV-1 infection between January 1\u003csup\u003est\u003c/sup\u003e, 2021-July 31\u003csup\u003est\u003c/sup\u003e, 2022, with the prescription of BIC/FTC/3TC or DTG/3TC as the current treatment were included. Patients’ responses were collected through a digital platform and the HRQoL were measured by three questionnaires, including HIV-symptom index (HIV-SI) questionnaire, Patient Health Questionnaire‐9 (PHQ-9) and the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L). Generalized linear regression model was used to estimate the effects of covariates on each HRQoL measure.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eA total of 143 HIV patients with HRQoL data available were included in the study. The mean (SD) of HIV-SI total score, PHQ-9 total score and EQ-5D utility score was 26.7 (14.4), 7.4 (1.0) and 0.95 (0.12), respectively. Compared with treatment-naive patients, treatment-experienced patients reported significantly higher score/proportion of HIV-SI and PHQ-9 total score, presence of depression and problems in anxiety/depression (all p\u0026lt;0.05). Patients with older age, without formal work, having treatment switch due to safety reason and lower CD4 cell counts had significantly higher HIV symptom burden and worse depression status, respectively (all p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eHIV patients suffer from HIV symptoms and depression, which greatly deteriorate their HRQoL. Considering the aging population and lower employment rate, the needs for social support or patient-assistant program for HIV patients are highlighted. The early initiation of INSTI-based regimens is necessary to avoid the HRQoL loss due to safety reasons.\u003c/p\u003e","manuscriptTitle":"Measuring the health-related quality of life in HIV patients with integrase strand transfer inhibitor-based regimens in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 17:08:57","doi":"10.21203/rs.3.rs-4635838/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e414e11e-d0a5-48be-b651-f57ee7b9b74e","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T22:39:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 17:08:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4635838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4635838","identity":"rs-4635838","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}