Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Lorena Baccaglini, PhD, DDS, MS; Associate Professor, Department of Epidemiology

Second Committee Member

Howard S. Fox, M.D., Ph.D.; Professor, Pharmacology and Experimental Neuroscience; Senior Associate Dean, College of Medicine Research and Development

Third Committee Member

Christopher S. Wichman, PhD; Assistant Professor, Department of Biostatistics


Background: Despite the use of combination antiretroviral therapy, HIV associated neurocognitive impairment (NCI) persists in HIV seropositive persons, albeit in milder forms than before therapy was available. Nevertheless, the relationship between NCI and health-related quality of life (HRQoL) is not well known.

Method: Baseline data from the CHARTER study was used to investigate the association between NCI and HRQoL. Factor analysis was employed to summarize the 35-item Medical Outcome Survey questionnaire into physical and mental HRQoL scores. General linear models were employed to investigate the association between NCI, as measured by global deficit scores (GDS), and HRQoL, and to control for confounding.

Results: A total of 1,340 HIV participants were analyzed, including 35.6% NCI, 77.2% males, 70.5% unemployed, and 42.2% depressed. The mean (standard deviation) mental HRQoL scores (lower scores are worse) for impaired and unimpaired participants were 64.0 (18.4) and 67.9 (18.6) and mean physical HRQoL scores for impaired and unimpaired participants were 60.3 (24.7) and 65.1 (25.9), respectively. There was an inverse association between NCI and mental HRQoL in unadjusted [-4.38 (-6.70 to -2.06)] and adjusted analysis [-2.56 (-4.83 to -0.30)], controlling for unemployment and current psychotropic medication use. The association between NCI and physical HRQoL was significant in the unadjusted analysis [-4.62 (-7.45 to -1.78)] but not in the adjusted analysis [2.20 (-4.81 to 0.40)], controlling for unemployment, CD4 nadir, and positive opiate test results and other covariates.

Conclusion. The inverse association between NCI and HRQoL was confounded mainly by employment and mediated by depression. Interventions aimed at the comprehensive treatment of HIV patients should include the management of depression and maintenance of employment.

Available for download on Thursday, April 29, 2021

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