Tuberculosis/HIV coinfection from the perspective of quality of life: scope review

Carvalho, Marcos Vinícius de Freitas; Taminato, Mônica; Bertolozzi, Maria Rita; Nichiata, Lúcia Yasuko Izumi; Fernandes, Hugo; Hino, Paula

doi:10.1590/0034-7167-2020-0758

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 74 (3) • 2021 • https://doi.org/10.1590/0034-7167-2020-0758 copy

Tuberculosis/HIV coinfection from the perspective of quality of life: scope review

La coinfección tuberculosis/VIH en la perspectiva de calidad de vida: revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze evidence on the quality of life of people with tuberculosis/HIV coinfection.

Methods:

review that followed steps of the Cochrane Collaboration, with the search of publications in the bases Embase, LILACS, PubMed, and Cochrane, through the descriptors “HIV,” “Tuberculosis,” and “Quality of Life,” without a temporal cut.

Results:

the results include 15 studies, published between 2009 and 2019, with the level of evidence V, in its majority. It was observed that there is no uniformity in the instrument used. Psychological support to this group and strengthening of actions to manage both infections are necessary. This segment’s quality of life is associated with social factors and scientific production on the subject concentrated in underdeveloped countries.

Conclusions:

the articles found have a low level of scientific evidence and indicate that people who experience coinfection have a more compromised quality of life when compared to those who experience tuberculosis or HIV separately.

Descriptors:
Tuberculosis; HIV; Quality of Life; Public Health; Community Health Nursing

Title / Level of evidence	Year/ Country	Method/Number of participants/Evaluation instrument	Main results	Conclusion
Coinfection HIV/tuberculosis (Pott's disease): a case study⁽¹³13 Ribeiro KCS, Lima KMSR, Loureiro AD. Coinfection HIV/tuberculosis (Pott´s disease): a case study. DST J Bras Doenças Sex Transm [Internet]. 2009 [cited 2020 Jul 30];21(2):83-6. Available from: http://www.dst.uff.br/revista21-2-2009/7%20-%20Coinfeccao%20HIV-tuberculose.pdf http://www.dst.uff.br/revista21-2-2009/7... ⁾ V	2009 Brazil	Case study n = 1 with TB/HIV coinfection Did not use an instrument	Non-adherence to treatment, or abandonment, of TB and HIV is one of the significant coinfection problems, resulting in a decrease in QoL due to therapeutic failures and resistance to the drugs used. The non-acceptance of diagnoses, the socioeconomic level, low schooling, and prejudice are intimately related to this problem.	The interaction between HIV and TB increased morbidity and mortality, resulting in lower perceived QoL.
Tuberculosis and HIV coinfection: its impact on quality of life⁽¹⁴14 Deribew A, Tesfaye M, Hailmichael Y, Negussu N, Daba S, Wogi A, et al. Tuberculosis and HIV co-infection: its impact on quality of life. Health Qual Life Outcomes. 2009;7:105. https://doi.org/10.1186/1477-7525-7-105 https://doi.org/10.1186/1477-7525-7-105... ⁾ V	2009 Ethiopia	Cross-sectional study n = 124 with TB/HIV coinfection and 467 with HIV HOQoL-HIV and Kessler-10	Patients with TB/HIV coinfection showed lower QoL in all domains when compared to HIV-infected without TB. Not having depression, having an income source, and family support were strongly associated with most QoL domains. In patients with both diseases, those who had depression were 8.8 times more likely to have physical health problems.	The TB control program should develop strategies to improve the QoL of people with TB/HIV coinfections. Depression and self-stigma/self-disapproval should be the targets for intervention to improve QoL.
Aids and tuberculosis: coinfection from the perspective of the patients' quality of life⁽⁷7 Neves LAS, Canini SR, Reis RK, Santos CB, Gir E. Aids and tuberculosis: coinfection from the perspective of the quality of life of patients. Rev Esc Enferm USP. 2012;46(3):704-10. https://doi.org/10.1590/S0080-62342012000300024 https://doi.org/10.1590/S0080-6234201200... ⁾ V	2012 Brazil	Cross-sectional study n = 57 with TB/HIV coinfection and 58 with HIV WHOQoL-HIV Bref	In the evaluation of QoL, those who experienced coinfection presented inferior results in all domains, with a significant difference in the Physical, Psychological, Level of Independence, and Social Relations domains.	It is necessary to develop joint policy strategies to reduce the epidemiological impact of one disease on another, such as early detection, implementation of ART, investigation of TB in people with HIV, treatment of latent TB, expansion of DOT, and training of professionals, enabling increased QoL for those affected by coinfection.
Health-related quality of life among patients with tuberculosis and HIV in Thailand⁽¹⁵15 Kittikraisak W, Kingkaew P, Teerawattananon Y, Yothasamut J, Natesuwan S, Manosuthi W, et al. Health related quality of life among patients with tuberculosis and HIV in Thailand. PLoS One. 2012;7(1):e29775. https://doi.org/10.1371/journal.pone.0029775 https://doi.org/10.1371/journal.pone.002... ⁾ V	2012 Thailand	Cross-sectional study n = 222 with TB/HIV coinfection Structured questionnaire; EuroQol (EQ-5D); EuroQol Visual Analog Scale (EQVAS)	The QoL score was higher among patients cured of TB; and lower for those in treatment of pharmaco-resistant TB.	The treatments for TB and the resistant form negatively impacted the patients' self-perceived health status, but this effect diminished after the successful treatment. There is a need for research that presents strategies to improve QoL in such conditions.
Quality of life among tuberculosis (TB), TB retreatment and/or TB-HIV coinfected primary public health care patients in three districts in South Africa⁽¹⁶16 Louw J, Peltzer K, Naidoo P, Matseke G, Mchunu G, Tutshana B. Quality of life among tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health care patients in three districts in South Africa. Health Qual Life Outcomes. 2012;ID77. https://doi.org/10.1186/1477-7525-10-77 https://doi.org/10.1186/1477-7525-10-77... ⁾ V	2012 South Africa	Cross-sectional study n = 2,935 with TB/HIV coinfection and 1,965 with tuberculosis Kessler-10; AUDIT; Two alternative questions; Social Functioning 12	Positive effects for QoL were found in the domains of mental health, emotional role, energy and fatigue, social function, and physical role, while adverse effects were observed on general health, body pain, and physical function. Higher schooling, less psychological suffering, less chronic conditions, less poverty, and low psychological suffering had positive effects on QoL.	TB and HIV have weakened patients' physical capacity and damaged QoL, so TB control programs must develop strategies to improve the QoL of patients who experience coinfection.
Quality of life aspects of patients with HIV/ tuberculosis coinfection⁽⁸8 Lemos LA, Feijão AR, Gir E, Galvão MTG. Quality of life aspects of patients with HIV/tuberculosis co-infection. Acta Paul Enferm. 2012;25(sple):41-7. https://doi.org/10.1590/S0103-21002012000800007 https://doi.org/10.1590/S0103-2100201200... ⁾ V	2012 Brazil	Cross-sectional study, qualitative and quantitative n = 34 with TB/HIV coinfection HAT-QoL	QoL has shown itself impaired in areas related to economic, sexual, and diagnostic confidentiality issues. It was also evidenced that coinfection imposes changes in daily life that potentiated the commitment of QoL.	Experiencing coinfection has negatively influenced QoL. Health-promoting interventions could mitigate repercussions.
Change in quality of life: a follow up study among patients with HIV infection with and without TB in Ethiopia⁽¹⁷17 Deribe A, Deribe K, Reda AA, Tesfaye M, Hailmichael Y, Maja T, et al. Change in quality of life: a follow up study among patients with HIV infection with and without TB in Ethiopia. BMC Public Health. 2013;29;13:408. https://doi.org/10.1186/1471-2458-13-408 https://doi.org/10.1186/1471-2458-13-408... ⁾ III	2013 Ethiopia	Observational n = 97 with TB/HIV coinfection and 455 with HIV WHOQoL-HIVBref; Kessler-10.	There was an improvement in physical, psychological, social, environmental, and spiritual QoL throughout the treatment, and it was more remarkable in all dimensions for those who experienced coinfection. The severe mental disorder was associated with worse QoL.	ART and TB treatment have improved QoL, particularly among patients experiencing coinfection. The recommendation is to integrate mental health services with TB/HIV programs and training of caregivers to identify and treat common mental disorders in due course and improve QoL.
'I cry every day': experiences of patients coinfected with HIV and multidrug-resistant tuberculosis⁽¹⁸18 Isaakidis P, Rangan S, Pradhan A, Ladomirska J, Reid T, Kielmann K. 'I cry every day': experiences of patients co-infected with HIV and multidrug-resistant tuberculosis. Trop Med Int Health. 2013;18(9):1128-33. https://doi.org/10.1111/tmi.12146 https://doi.org/10.1111/tmi.12146... ⁾ V	2013 India	Qualitative n = 12 with multipharmaresistant TB/HIV coinfection, 5 lay caregivers, 10 healthcare professionals Did not use an instrument	The side effects of the medications were considered seriously debilitating. Family caregivers are crucial to maintaining patients' mental and physical health, but they also report high fatigue and stress levels. Health professionals stated that the barriers to treatment compliance were fundamentally social, not medical and that they felt powerless in the face of this situation.	The treatment of pharmaco-resistant TB in PLWHAs requires the dedication of patients, caregivers, and family. Treatments consume many resources and can negatively affect QoL, so they require high levels of support from family and caregivers to encourage patient compliance and retention.
Quality of life among people treated for tuberculosis and human immunodeficiency virus in Rio de Janeiro, Brazil⁽¹⁹19 Dowdy DW, Israel G, Vellozo V, Saraceni V, Cohn S, Cavalcante S, et al. Quality of life among people treated for tuberculosis and human immunodeficiency virus in Rio de Janeiro, Brazil. Int J Tuberc Lung Dis. 2013;17(3):345-7. https://doi.org/10.5588/ijtld.12.0123 https://doi.org/10.5588/ijtld.12.0123... ⁾ V	2013 Brazil	Cross-sectional study n = 9 with TB/HIV coinfection, 45 with HIV and 44 with TB MOS-HIV and VAS (visual analogic scale)	Participants with TB/HIV coinfection reported less physical health than participants with TB or HIV alone, but there was no difference in mental health. Participants who had TB or HIV separately did not differ regarding QoL or mental health, but TB was associated with worse physical health.	There are similar decreases in QoL in participants undergoing HIV and TB treatment with no evidence of an additive effect in participants with TB/HIV coinfection.
'I'm fed up': experiences of prior antituberculosis treatment in patients with drugresistant tuberculosis and HIV⁽²⁰20 Furin J, Isaakidis P, Reid AJ, Kielmann K. 'I'm fed up': experiences of prior anti-tuberculosis treatment in patients with drug-resistant tuberculosis and HIV. Int J Tuberc Lung Dis. 2014;18(12):1479-84. https://doi.org/10.5588/ijtld.14.0277 https://doi.org/10.5588/ijtld.14.0277... ⁾ V	2014 India	Qualitative n = 12 with coinfection Pharmacorresistant TB/HIV Did not use an instrument	The study participants reported long therapeutic itineraries related to the diagnostic procedures and the treatment period, leading to fatigue. They also expressed concern about the lack of effectiveness of the treatment, based on past experiences.	Participants reported negative experiences with previous treatments for HIV and TB, which affected perceived QoL. Diagnosis and initiation of treatments in a quick and timely manner, coupled with a patient-centered support system, could help raise the credibility of the treatments.
Assessing Quality of Life and Depression Among People Living With HIV/AIDS and TB-HIV coinfection in Kathmandu, Nepal⁽²¹21 Timilsina S, Regmi K. Assessing quality of life and depression among people living with HIV/AIDS and TB-HIV Coinfection in Kathmandu, Nepal. SAARC J Tuberc, Lung Dis HIV/AIDS. 2015;10(3126). https://doi.org/10.3126/saarctb.v11i2.12428 https://doi.org/10.3126/saarctb.v11i2.12... ⁾ V	2015 Nepal	Cross-sectional study n = 71 with TB/HIV coinfection and 75 with HIV WHOQoL-HIV, Beck Depression Inventory Scale.	Participants with TB/HIV coinfection had low QoL, and depression was more frequent than HIV-infected participants. CD4 cell count, educational status, occupation, ethnicity, family size, and depression were factors related to QoL.	TB control programs should develop strategies to improve the QoL of people with coinfection, just as there should be interventions aimed at depression to improve the QoL of people living with HIV, with or without TB.
Longitudinal assessment of the health-related quality of life of HIV infected patients treated for tuberculosis and HIV in a high burden setting⁽²²22 Mthiyane T, Pym A, Dheda K, Rustomjee R, Reddy T, Manie S. Longitudinal assessment of health related quality of life of HIV infected patients treated for tuberculosis and HIV in a high burden setting. Qual Life Res. 2016;25(12):3067-76. https://doi.org/10.1007/s11136-016-1332-4 https://doi.org/10.1007/s11136-016-1332-... ⁾ III	2016 South Africa	Observational n = 76 with TB/HIV coinfection HRQoLx	There was a significant increase in the total score in both groups with the months' passing, considering mainly the CD4 cell elevation. There was no difference in scores between participants who underwent ART and TB treatment and those who received only TB treatment. Less adverse respiratory events were positively related to better QoL.	There was improvement in QoL related to the decrease of adverse events and signs and symptoms of TB. Lower QoL was related to the number and type of adverse events although there was a cure of TB.
Health-related quality of life of HIV patients with and without tuberculosis registered in a Tertiary Hospital in Port Harcourt, Nigeria⁽²³23 Kanu NE, Tobin-West CI. Health-related quality of life of HIV patients with and without tuberculosis registered in a Tertiary Hospital in Port Harcourt, Nigeria. HIV AIDS Rev. 2018;17:3(210-17). https://doi.org/10.5114/hivar.2018.78494 https://doi.org/10.5114/hivar.2018.78494... ⁾ V	2018 Nigeria	Cross-sectional study n = 144 with TB/HIV coinfection and 144 with HIV WHOQoL-HIV	Patients who experienced coinfection had lower QoL in the physical, psychological, and global domains than patients with HIV. The two groups did not differ significantly in the Social and Environmental domains.	The TB/HIV condition has significantly reduced QoL; therefore, attention should be focused on managing the physical and mental health of patients experiencing coinfection in order to improve QoL.
Social support and quality of life of people with tuberculosis/HIV⁽²⁴24 Neves LAS, Castreghinic C, Reis RK, Canini SEM, Gir E. Social support and quality of life of people with tuberculosis/HIV. Enferm Glob. 2018;50:1-5. https://doi.org/10.6018/eglobal.17.2.276351 https://doi.org/10.6018/eglobal.17.2.276... ⁾ V	2018 Brasil	Cross-sectional study n = 57 with TB/HIV coinfection WHOQoL-HIV Bref; Escala de Apoio Social para Pessoas Vivendo com HIV/ AIDS; e questionário.	Positive associations were found between social support and QoL, and a relationship was identified between instrumental support and the Physical and Social Relations domains. Emotional support was related to all domains except Spirituality.	Clinical manifestations and fear of stigma have affected social relationships of people who experience TB/HIV coinfection, causing a negative impact on QoL; in contrast, support from family, friends and health professionals has increased self-esteem and adherence to treatment, acting positively in QoL.
Quality of life among HIVtuberculosis coinfected patients⁽²⁵25 Jha DK, Jha J, Jha AK, Achappa B, Holla R. Quality of life among HIV-tuberculosis co-infected patients. Perspect Clin Res. 2019;10(3):125-9. https://doi.org/10.4103/picr.PICR_99_18 https://doi.org/10.4103/picr.PICR_99_18... ⁾ III	2019 India	Cross-sectional study n = 26 with TB/HIV coinfection and 78 with HIV WHOQoL-HIV; Beck Depression Inventory Scale.	Participants with TB/HIV coinfection scored lower in all domains than participants who experienced HIV exclusively, suggesting that patients with coinfection have a lower QoL.	It is imperative to identify the determinants and work for improved QoL of people living with HIV.

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[1] Corresponding author: Marcos Vinícius de Freitas Carvalho. E-mail: mvcarvalho.carvalho@gmail.com