Thomas, R., Burger, R., Harper, A., et al. The Lancet Global Health (September 2017), 5(11): e1133-41, doi:10.1016/52214-109X(17)30367-4.
This paper used cross-sectional population surveys to compare differences in the health-related quality of life (HRQoL) between HIV-positive and HIV-negative individuals in Zambia and South Africa The authors randomly sampled households with individuals aged 18–44 years to measure five domains: mobility, self-care, daily activities, pain, and anxiety or depression. In Zambia, 19,750 individuals were included and 21 percent were HIV-positive. In South Africa, 18,941 individuals were included and 22 percent were HIV-positive. In Zambia, HIV-positive individuals reported lower HRQoL than HIV-negative individuals, with pain scores significantly higher among HIV-positive individuals. In South Africa, there were no differences, except for anxiety or depression which was slightly higher among HIV-positive individuals. Among individuals who were of aware of their HIV-positive status but had not yet started antiretroviral treatment (ART) or enrolled in care, there was a slightly lower HRQoL in comparison to HIV-negative individuals. Those who had never started ART were also more likely to report challenges with mobility, self-care, or daily activities. In both countries, those who knew they were HIV-positive but had not yet enrolled in care were more likely to report depression or anxiety. The authors concluded that ART can improve the HRQoL of HIV-positive individuals.