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Systematic Review

The Quality of Life of Patients with HIV/AIDS Undergoing Antiretroviral Therapy: A

Systematic Review

Putri Irwanti Sari, RTS Netisa Martawinarti, Nurmawati S. Lataima, and Vivi Meiti Berhimpong
Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

ABSTRACT ARTICLE HISTORY

Introduction: Quality of Life (QoL) is one of the most important things for a Received: Dec 26, 2019
patient with HIV/AIDS. Good QoL will improve the adherence to treatment, Accepted: Dec 31, 2019
especially antiretroviral therapy. The purpose of this study was to explore
about the quality of life of the patients with HIV/AIDS undergoing KEYWORDS
antiretroviral therapy. antiretroviral; HIV//AIDS; quality of
life
Methods: The data was collected through a literature review from
electronic databases such as Scopus, ProQuest, Google Scholar and CONTACT
Springerlink journal. The keywords were "quality of life", "HIV/AIDS",
Puteri Irwanti Sari
"quality of life of patients with HIV/AIDS" or "quality of life and HIV/AIDS  putri.wanti.sari-
and antiretroviral therapy". [email protected]
Results: The researcher obtained 15 articles based on the inclusion criteria.  Faculty of Nursing, Universitas
Airlangga, Surabaya, Indonesia
Several research articles that were analyzed showed that the Quality of Life
of HIV/AIDS patients undergoing antiretroviral therapy was not all good.
This is caused by the side-effects of using antiretroviral therapy and the
side-effects that were physical, psychological, social and environmental.
Conclusion: The impact of the side effects of antiretroviral therapy has
caused the clients with HIV/AIDS to choose other therapies such as ART
replacement therapy to improve the quality of life for patients with
HIV/AIDS.

Cite this as: Sari, P. I., Martawinarti, R. N., Lataima, N. S., & Berhipong, V. M. (2019). The Quality of Life of Patients with
HIV/AIDS Undergoing Antiretroviral Therapy: A Systematic Review.Jurnal Ners, 14(3si), 50-54.
doi:http://dx.doi.org/10.20473/jn.v14i3(si).16978

patients in low- and middle-income countries do not

INTRODUCTION
immediately start antiretroviral therapy (ART)
Recently, HIV infection has been considered to be a despite being eligible for ART(Daniels et al., 2018).
chronic disease because the effective dissemination The results of the study by Linlin Lindayani meant
of antiretroviral therapy has lengthened the life that the overall WHOQOL-HIV score was 78.9 (SD =
expectancy of people living with HIVWHO. It has been 9.08; range; 46-101). There were no significant
noted that since AIDS was discovered and up until the differences in the WHOQOL-HIV domain scores at
end of 2014, 34 million people had died and in 2014, various stages of the disease after controlling for
1.2 million people died of the virus. There were 36.9 potential confounders (Lindayani, Chen, Wang, & Ko,
million people living with HIV in the world at the end 2018).
of 2014. The goal of sustainable development goals Health-related quality of life (HRQoL) is a broad
(SDG) is to stop the HIV / AIDS epidemic in the world concept that reflects the patients' general subjective
by 2030. In 2016, around 36.7 million people were perceptions of the effects of disease or interventions
living with HIV around the world. Indonesia was on the physical, psychological and social aspects in
ranked as having the third largest number of people their daily lives. HRQoL among HIV-infected patients
living with HIV (PLWHA) in the Asia and Pacific has become an important indicator of the impact of
region (Ortblad, Lozano, & Murray, 2013). Many HIV the disease and treatment outcomes. A cross-

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Figure 1. PRISMA

sectional survey was conducted at the Chitungwiza selected the same article (duplicate article) published
Central Hospital, Zimbabwe, to assess the HRQoL in from Scopus, ProQuest and SpringerLink, selected
patients with HIV / AIDS who received antiretroviral based on the suitability of the article title with the aim
therapy (ART) using two validated instruments. The of systematic review. We then filtered based on the
targeted quality of life for HIV / AIDS (HAT-QoL) and research where one of the samples in the study must
the EuroQoL Five-dimensional three-level be adults or couples > 18 years; 40 articles were then
instruments (EQ-5D-3L) were used to assess HRQoL obtained. Of the 40 articles selected, 15 were
(Mafirakureva, Dzingirai, Postma, van Hulst, & Khoza, analyzed.
2016). Therefore, it is necessary to further analyze Studies meeting the following criteria were
the quality of life of patients undergoing included in the systematic review: (1) full-text
antiretroviral therapy to determine the effects of articles published in English, (2) research articles
antiretroviral therapy for patients with HIV / AIDS. from the period 2013-2018, (3) different types of
quantitative research, (4) articles where the main
MATERIALS AND METHODS content was HIV/AIDS patients undergoing
antiretroviral therapy and (5) the samples in the
The systematic review was conducted using a
study must be adults or couples > 18 years. The
standard methodology as published by IOP
exclusion criteria in the systematic review were (1) a
Introductory guide for authors. We followed the
wrong study design, (2) no relevant outcomes and (3)
Preferred Reporting Item for Systematic Reviews and
unpublished full-text or unable to obtain the full text.
Meta-analyses (PRISMA) guidelines. This systematic
review was made in such a way to get answers about
RESULTS
the quality of life of HIV/AIDS patient undergoing
antiretroviral therapy. The total respondents in this review were 45,377
The process used to conduct the systematic people with the disease (HIV/AIDS) who received
review involved reviewing several research articles antiretroviral therapy. The area in this study was
published through electronic databases. The hospitals and communities. Of the 15 articles
electronic databases used were Scopus, ProQuest, selected, research was conducted in Indonesia, South
Google Scholar and SpringerLink. The keywords for Africa (KwaZulu-Natal, Cape Town), Botswana, the
the journals in English were "Quality of life", Republic of Zimbabwe, Zambia, Ethiopia, India and
"HIV/AIDS", "Quality of life of patients with Kenya. All of the articles analyzed according to the
HIV/AIDS" or "Quality of life and HIV/AIDS and type of research are quantitative approaches (n = 15).
antiretroviral therapy". The search results found in The most widely used research design was
ProQuest totaled 87.223 journals, and Scopus had correlation with a cross-sectional approach (n = 13)
1,302 journals and Google Scholar had 75,800 and a prospective cohort (n = 2). In connection with
journals so the total journals found were 164.325. The the year of publication, the research articles were
journals found were specified based on the inclusion published in the range of 2013-2018. All of the
criteria. After adjusting for the inclusion criteria, the samples in the study were HIV / AIDS patients who
missing articles made up 843 documents. We then were on antiretroviral therapy (ART). The most

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P. I. SARI, ET AL.

Table 2. Studies that formed the basis of the systematic review

Author Type of Study Respondents Instrument Outcome
(Maiese, Johnson, MOS-HIV The patient has improved an
Bancroft, Goolsby Cohort study 134 clients with HIV DASS-21 quality of life after replacing the
Hunter, & Wu, 2016) HIV TSQs antiretroviral therapy regimen
The main priority was the sleep
(Lindayani et al., 2018) Epidemiology 215 respondents WHOQoL-BREF problem
ART can improve quality of life
HRQoL HAT-QoL
Higher levels of HRQoL are
EQ-5D-3L
(Mafirakureva et al., 257 clients with positively and significantly
Epidemiology Euro QoL
2016) HIV/AIDS related to income, education
VAS
and employment.
(Munene & Ekman, SF-36 HRQol Antiretroviral therapy is
Epidemiology 421 clients with HIV
2014) PCS negatively related to HRQoL
Use of antiretroviral therapy
(Narsai, Jinabhai,
EQSD The majority of the
Taylor, & Stevens, Descriptive 600 respondents
EQ-VAS respondents were young
2016)
women
The domain of the environment
(Ndubuka, Lim, Ehlers, 456 HIV clients on WHOQoL-HIV- got the lowest score
Descriptive
& Van Der Wal, 2017) ART BREF The Quality of life for PLWHA is
bad
HRQoL There is no significant
903 HIV clients on
(Nglazi, 2014) Descriptive EQ-5D relationship between the
ART
EQ-5D-VAS groups for most Eq-5D domains
(Amanuel, Abebe,
494 HIV clients on Family support for the clients
Mulusew, & Hailay, Descriptive WHOQOL- BREF
ART with low ART
2015)
38691 respondents, HRQOL
19750 from Zambia, HRQOL There is no difference between
(Thomas et al., 2017) Descriptive
and 18941 from EQ-5D-5L HIV-positive and HIV-negative
South Africa HRQoL
(Tomita, Garrett,
160 clients with
Werner, Burns, Cohort FAHI HRQoL increases
HIV/AIDS
Mpanza, et al., 2014)
160 clients with ART
(Tomita, Garrett,
cohorts (n=51 and HRQoL Non-initiation ART HRQoL was
Werner, Burns, Cohort
non-initiating ART FAHI higher than cohort ART
Ngcobo, et al., 2014)
(n=191)
1180 clients with HAT-QOL
(Vo et al., 2016) Descriptive Low life satisfaction
HIV HRQOL
Quality of Life
(Torres, Harrison, La
There is ART failure
Rosa, Lavenberg, et al., Descriptive 512 clients with HIV QoL Based
Compliance with treatment
2018)
Decreasing the virus load
(Torres, Harrison, La
Rosa, Cardoso, et al., Descriptive 512 clients with HIV QoL Based Quality of life can be improved
2018)
(Pokhrel, Gaulee Compliance with ART
682 clients using WHOQOL-HIV-
Pokhrel, Neupane, & Descriptive treatment
ART BREF Scale
Sharma, 2018) QOL

widely used research instruments when assessing the of antiretroviral therapy has caused the clients with
quality of life of patients with HIV / AIDS was the Euro HIV/AIDS to use other therapies such as Nucleoside
Quality of Life Instrument, the Functional Assessment reverse transcriptase inhibitor (NRTI) replacement
of HIV Infection (FAHI) Instrument, WHOQoL-HIV to Non-Nucleoside reverse transcriptase inhibitor
BREF, Euro Quality Visual Analog Scale (EQ-5D VAS), (NNRTI) therapy to improve the quality of life for
HAT -QoL, HRQoL (EQ 5D), MOS-HIV, DASS-21, HIV patients with HIV/AIDS.
TSQs, others use WHOQOL-BREF, HRQL SF 36, MCS,
and PCS. Several of the research articles that were DISCUSSION
analyzed showed that the Quality of Life of HIV/AIDS
The systematic review of the quality of life of patients
patients undergoing antiretroviral therapy was not
with HIV/AIDS who are undergoing antiretroviral
good across the board. This is caused by the side
therapy is very necessary to improve their
effects of using antiretroviral therapy and the side
understanding of the quality of life of patients as the
effects include physical, psychological, social and
most widely used instruments. The factors that affect
environmental factors. The impact of the side effects

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quality of life and the complaints most often felt by CONCLUSION

patients can be the input for medical personnel
including nurses in improving the quality of life of Various countries have examined the quality of life of
patients undergoing antiretroviral therapy. Besides HIV/AIDS patients undergoing antiretroviral therapy
that, it also helps other medical personnel to and the results of their research show that not all of
collaborate to improve the patients' quality of life. the patients' quality of life is good. This was due to the
Some articles show that the patients experience side effects of the antiretroviral therapy. Therefore
problems when using antiretroviral therapy. This can the clients with HIV choose to use other therapies as
affect the quality of life of the patients. Quality of life ART replacement therapy to improve their quality of
is the concept of the analysis of individuals to get a life with HIV/AIDS. We found that HIV patients whose
normal life related to the individual perceptions of the regimen was switched due to treatment-related side-
goals, expectations, standards and special attention to effects experienced an improvement in QoL. Further
life experienced by being influenced by cultural research is needed on the effects of ART and ART
values in the individual environment. There are four replacement therapy and into the client's experience
domains that are used as parameters to determine with ART on quality of life. The findings in this study
quality of life, and each domain is described in several suggest that physicians should take the potential
ways: the physical health domain, psychological impact of QoL into consideration when making
domain, social relations domain and environmental decisions on a switch in ART regimen, particularly
domain. when the patients are intolerant of their current
Good quality of life will improve the adherence to treatment.
therapy. Adherence is very important in
antiretroviral treatment because if the drug do not
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