Introduction:With the advent and use of highly active antiretroviral therapy (HAART), there has been a marked reduction in morbidities and mortalities resulting from the human immunodeficiency virus (HIV) infection. However, little is known about the health-related quality of life (HRQoL) among long-term HAART users. This study sought to systematically examine literature to investigate the potential impact of long-term HAART use on HRQoL.

Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases (MEDLINE, CINAHL, Cochrane CENTRAL, EMBASE, PsychInfo) were searched from January 1992 for empirical studies which assessed HRQoL outcomes (physical, emotional, mental, vitality, labor productivity).

Results:Preliminary screening of titles/abstracts and full-text articles obtained through literature search yielded 26 studies. Majority of studies reported increased overall HRQoL score for patients using HAART, short-term (a couple of months), when compared to treatment-naïve patients. The HRQoL measures most affected by long-term use of HAART were physical functioning and vitality. Some studies described a deterioration in physical wellbeing and mental health with continued HAART usage despite increased CD4 count, lower viral load, and reduced hospitalizations rates.

Discussion:While clinical results indicate health improvements (high CD4, low viral load) when placed on HAART, overall effect of HAART on HRQoL is a delicate balance between reduced HIV-related morbidities and potential medication side-effects. Competing definitions for “long-term” and “quality of life” for HAART users at various times in their disease trajectories highlight the need for more robust longitudinal studies able to investigate the long-term quality of life impact of HAART use.