Health-related quality of life in people living with HIV on first-line INSTI versus those switched from EFV to INSTI: a cross-sectional study from four cities in China

BACKGROUND: With the widespread use of integrase strand transfer inhibitors (INSTIs) among people living with HIV (PLWH) in China, their impact on health-related quality of life (HRQOL) requires urgent evaluation. This study aimed to compare HRQOL between PLWH on first-line INSTI-based regimens and those switched from efavirenz (EFV) to INSTI, and explore factors associated with HRQOL in this INSTI-using population. METHODS: A cross-sectional survey was conducted in four tertiary infectious disease hospitals in China from January to February 2025. People living with HIV receiving INSTI-based regimens were enrolled. Data on sociodemographic characteristics were collected through face-to-face interviews, while clinical data were obtained from physical examinations, laboratory tests and medical records. Self-reported HRQOL was assessed using the WHOQOL-HIV BREF instrument. Multivariable linear regression models were used to analyze influencing factors. RESULTS: A total of 567 PLWH (mean age 37.0 years; 97.2% male) were included in the study. There were 312 (55.0%) first-line INSTI users and 255 (45.0%) participants who had switched from EFV to INSTI. Multivariable analysis showed that scores in the general health item of HRQOL were significantly higher among first-line INSTI users compared to those switched from EFV to INSTI (B = 0.21, 95% CI: 0.05 - 0.37, p = 0.011). Additionally, a greater number of comorbidities was negatively associated with the general quality of life (QOL), general health, independence, and social relationships. An educational level of university or above, a higher monthly income (≥ 5000 CNY), and an antiretroviral therapy (ART) duration of ≥ 2 years were positively associated with higher scores in some HRQOL domains, while full-time employment status was associated with decreased scores in the psychological and social relationships domains. CONCLUSION: In this cross-sectional survey of PLWH in China, first-line INSTI use was associated with modestly better HRQOL only in the general health item, compared with switching from EFV, without evidence of broader HRQOL superiority across other domains. Beyond regimen type, greater comorbidity burden was negatively associated with HRQOL.