Introduction

Since achievement of a good quality of life (QOL) was granted as the 4th goal by UNAIDS, recent guidelines endorsed assessment of patient’s reported outcomes (PROs) in people with HIV (PWH) in routine clinical practice. Therefore, we decided to assess QOL by using PROs in PWH harboring 4-drug resistance (4DR) participating in the Italian PRESTIGIO registry, and assess factors associated with worst QOL outcomes in this cohort.

Methods

A cross-sectional survey-based study (including QoL, sleep disorders, mood disorders, treatment satisfaction, and resilience) was conducted within the Italian multicenter PRESTIGIO registry, including people able to fill-in the questionnaires. Questionnaires were administered to people who accepted to participate. Participant relevant information (ARV treatment, comorbidities, polypharmacy, HIV-history related characteristics) was retrieved by the PRESTIGIO Registry platform. Regression analyses were performed to identify associations between clinical/demographic features and lower QoL defined as EQ5D3L VAS < 90.

Results

From October 2024 to January 2025, 137 people responded to questionnaires, mainly males (69.3%), and with a mean age of 59 (SD:10), 90.5% (N=124) people had an undetectable HIV viral load. In our cohort, VAS was available for 132/137 persons, with 65% people disclosing a VAS < 90.

Features of the study population overall and by QOL (<90 and ≥ 90), with survey results are reported into Table 1. People with longer history of 4DR are more likely to have a VAS < 90 (p=0.022). People with a worst QoL reported significantly worst outcomes in every PROs (sleep, resilience,

mood disorders, and treatment satisfaction). When multivariable analysis was performed the only significant association with a worst QoL were years on ART (OR: 1,22, CI 1,05-1.44, p=0.014).

 

Discussion

This is the first real word evidence exploring PROs in a 4DR PWH. Although viral suppression was achieved despite prolonged exposure to antiretrovirals and multiple failures, QoL in every of the explored aspect and treatment satisfaction were quite poor. This is an urgent need to routinely assess PROs in this setting and to address modifiable factors affecting QoL, to achieve UNAIDS targets in this special population.