Patient-reported quality of life in people living with HIV in Romania: a cross-sectional PROM-based study.

Abstract

Background: In Romania, people living with HIV represent heterogeneous cohorts shaped by distinct epidemiological and social contexts. While antiretroviral therapy (ART) has markedly improved survival, quality-of-life (QoL) encompasses broader dimensions not fully captured by clinical indicators. Patient-reported outcome measures (PROMs) offer a valuable approach to understanding these dimensions in routine care.

Methods: We conducted a multicenter, cross-sectional study using the OCTAVE PROM to assess patient-reported health-related QoL among people with HIV in Romania. The self-completed questionnaire evaluates eight domains: ART, physical health, mental health, sleep quality, sexuality, emotional wellbeing, non-HIV-related health, social and professional life. Adults attending routine follow-up visits in HIV centers across Romania were consecutively enrolled between August 2024 and July 2025.

Results: In total, 1042 people with HIV completed the questionnaire (median age 36 years; 66.9% male). Over 95% of respondents reported being happy or very happy with treatment ease, adherence, tolerability, and information about ART. Lower levels of wellbeing were observed in the domains of sexuality (63.1%), sleep quality (74.8%), and social and professional life (77.0%). Sexuality was the most vulnerable domain and the only one showing consistent age-related differences, with progressively lower wellbeing reported in older age groups (all p < 0.001). Higher education was linked to better self-perceived physical functioning, emotional wellbeing, social integration, and financial security.

Conclusions: This large, multicenter PROM-based study demonstrates that while treatment-related QoL among people with HIV in Romania is high, challenges persist in sexuality, sleep, and social wellbeing. Educational level emerged as key determinant of patient-reported outcomes. Integrating PROMs into routine HIV care can enhance patient-centered approaches by identifying unmet needs beyond virological control and informing targeted, individualized interventions.