Perfis de qualidade de vida, atividade física e fadiga em pessoas vivendo com HIV: uma análise de clusters

Abstract

The Acquired Immune Deficiency Syndrome (AIDS) epidemic remains a major public health issue, with fatigue being a common chronic symptom that impacts quality of life and treatment adherence. Despite the control of the disease in Brazil through antiretroviral therapy, it is crucial to mitigate this symptom and investigate its relationship with quality of life and physical activity. Objective: To identify and characterize subgroups of people living with Human Immunodeficiency Virus (HIV) based on their quality of life profiles and physical activity levels, and to investigate the association of these profiles with the experience of fatigue. Methodology: The variables were categorized into sociodemographic factors (age, skin color, marital status, biological sex, education level); disease- and treatment-related factors (time since diagnosis, mode of transmission, infection stage, medication use, treatment adherence); and psychosocial and personal factors (fatigue, habitual physical activity, quality of life, disease perception, financial satisfaction, feelings of exclusion, and suffering due to stigma and/or prejudice). Data were collected at the Centro de Especialidade Médica de Aracaju (CEMAR) from 115 adults living with HIV and users of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PeP). Four questionnaires were applied: a sociodemographic questionnaire, the Fatigue Assessment Scale, the WHOQOL-HIV-Bref, and the Habitual Physical Activity questionnaire. Cluster analysis was conducted using hierarchical analysis with Ward's method and squared Euclidean distance, followed by K-means analysis, using Zscores for quality of life and total physical activity level, with convergence in four iterations. ANOVA and non-parametric tests were used for characterization and comparison between clusters. For comparisons of continuous variables among the three clusters, the Kruskal-Wallis test was performed, followed by pairwise comparisons with Bonferroni correction. For categorical variables, the chi-square test or Fisher's exact test was used. The relationship between the identified clusters and fatigue was analyzed using robust Poisson regression. Results: Cluster analysis identified three groups: Cluster 1 (high quality of life and physical activity), Cluster 2 (moderate quality of life and physical activity), and Cluster 3 (low quality of life and physical activity). Poisson regression showed that, compared to Cluster 3, participants in Cluster 1 had a 70.8% lower prevalence of fatigue (PR=0.29; 95% CI: 0.14-0.57; p<0.001), and those in Cluster 2 had a 30.7% lower prevalence (PR=0.69; 95% CI: 0.49-0.96; p=0.031). Conclusion: There is an association between negative perceptions of quality of life, lower physical activity levels, and greater experiences of fatigue among people living with HIV receiving care at CEMAR, Sergipe.