背景：愛滋病抗病毒藥物治療能延長其存活時間，愛滋病已成為需長期追蹤之慢性病，維持病人有良好的生活品質狀態可延長其存活時間。台灣HIV病人生活品質相關因素的研究有限，尤其缺乏長期縱貫性研究。

目的：描述2000年到2013年於成大醫院診斷HIV/AIDS病人之平均餘命與推估存活，以及於2007年至2012年就醫病人個案特性、環境因素、健康行為與生活品質之關係；確認AIDS/HIV病人生活品質之影響因素。

方法：此研究採縱貫性相關性研究設計、分析成功大學附設醫院之愛滋病資料庫內所蒐集之台灣版世界衛生組織生活品質量表簡明版 (WHOQOL-BREF)問卷及人口學基本屬性、社會支持量表(Social Support Rating Scale-SSRS)等結構式問卷資料，加上電子病歷回顧，以iSqoL、SPSS 20.0軟體進行統計分析。

結果：於2000-2013年間至成大醫院就診之大於18歲、未發病之HIV病人現今存活數據為155.58個月(12.97年)，推估可存活為453.64個月(37.80年)，對照台灣同樣年齡性別之人口平均餘命518.80個月(43.2年)減少了65.16個月(5.43年)。於成大醫院就診且大於18歲病發成AIDS之病人現今存活數據為128.36個月(10.70年)，推估可存活為352.66個月(29.39年)，對照台灣同樣年齡性別之人口平均餘命487.20個月(40.6年)減少了134.54個月(11.21年)。
2007至2012年間共有508人加入愛滋病個案管理計畫，其中248位(48.8%)提供444份完整填寫之問卷納入分析。以Mix model分析發現影響成大醫院愛滋病感染者整體生活品質最顯著的因子為自覺社會支持程度得分 (p <.001*, F =50.003)、性別(p =.001*, F =11.075)、就業情況(p =.006*,F=4.239)、接受HAART(p =.042*, F =4.153)。

結論: 愛滋病感染者之平均餘命比一般人低，缺乏社會支持與無穩定工作之HIV/AIDS病人其生活品質較差，健康照護者應針對上述族群提供照顧且給予協助使病人穩定就醫，而醫療團隊與個案管理模式可直接提供病人社會支持，並因應病人需求提供資源轉介，提升病人之生活品質與健康狀態。

SUMMARY
This study investigated the survival time and quality of life (QOL) of patients with HIV/AIDS at NCKUH) between 2007 and 2013. iSqol software was used to analyze the survival time and a mixed-effects model was generated using SPSS 20.0 software. The average survival time of patients with HIV at the NCKUH was approximately 155.58 months, and the longest survival time was 453.64 months.

The average survival time of patients with AIDS at the NCKUH was approximately 128.36 months, and the longest survival time was 352.66 months. The estimated survival time of patients with HIV is shorter than general population only 65.16 months. The major factors associated with QOL among patients living with HIV/AIDS at the NCKUH were social support, education level, and whether they were receiving highly active antiretroviral therapy.

INTRODUCTION
Antiretroviral therapy has been proven to prolong the survival time and decrease the mortality rate among patients with HIV/AIDS. HIV is a chronic disease and follow-up is necessary. To date, there is a lack of longitudinal studies in quality of life (QOL) among patients with HIV/AIDS in Taiwan.
The purpose of this study was to investigate the survival time of patients with HIV/AIDS and to identify the factors associated with QOL among individuals living with HIV/AIDS.

MATERIALS AND METHODS
This study was a longitudinal, retrospective follow-up study. Data were collected at NCKUH, including basic demographic characteristics, electronic medical records, QOL measured by the World Health Organization QOL-BREF questionnaire, and perceived social support measured by the Social Support Rating Scale (SSRS). iSqoL and SPSS 20.0 software were used for statistical analysis.

RESULTS AND DISCUSSION
In 2000-2013, 1241 patients received medical treatment at the NCKUH. The average survival time of patients with HIV treated at the NCKUH was approximately 155.58 months (65.16 months less than the general population). The average survival time of patients with AIDS at the NCKUH was approximately 128.36 months (134.54 months less than the general population).

During 2007-2012, 508 patients were enrolled in the HIV case-management program, and 444 complete questionnaires were available. According to the initial analysis of the QOL data, female (p < 0.001*) patients had high QOL scores at the NCKUH.

On repeat analysis of the QOL data using a mixed model, factors associated with the overall QoL were social support (p <.001*, F =50.003), gender ( p =.001*, F =11.075), Employment status(p =.006*, F=4.239),and receiving HAART (p =.042*, F = 4.153). The most significant factors for the physical domain were social support (p < 0.000*, F = 63.661), education level (p < 0.001*, F = 5.73), and receiving HAART (p <0.001, F = 12.87). In the psychological domain, the most significant factors were social support (p < 0.000*, F = 64.734), age (p = 0.004*, F = 3.94), education level (p = 0.006*, F = 4.17), and receiving HAART (p = 0.013, F = 6.30). In the social domain, the most significant factors were social support (p < 0.000*, F = 119.834), receiving HAART (p =< 0.001*, F = 14.325), and age (p = 0.009*, F = 3.46). In the environmental domain, the most affected factors were also social support (p < 0.000*, F = 97.482), age (p = 0.006*, F = 3.70), and receiving HAART (p = 0.007*, F = 7.29).

The average survival time of patients with AIDS is less than the general population; however, it is better than patients with HIV/AIDS during 1997-2001. More attention should be devoted to patients who are single, unemployed, have a lower education level, and lack of social support.

Alexander H. Miners,Caroline A. Sabin, Amanda Mocroft, Mike Youle,Martin Fisher and Margaret Johnson.(2001). Health-Related Quality of Life in Individuals Infected with HIV in the Era of HAART. HIV Clin Trials ,2(6),484–492.
Baldwin, S., Godfrey, C., Propper, C. (1990).The Quality of Life: Perspectives and Policies. Routledge, London. Culyer. Ferrans, C. E., & Powers, M. J. (1985). Quality of Life Indexs: Development and psychometric. Advanced in Nursing Science, 8(1), 15-24.
Bach Xuan Tran , Arto Ohinmaa , Long Thanh Nguyen , Pauline Oosterhoff, Phu Xuan Vu , Tam Van Vu & Mattias Larsson (2012): Gender differences in quality of life outcomes of HIV/AIDS treatment in the latent feminization of HIV epidemics in Vietnam, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 24:10, 1187-1196
Bach Xuan Tran (2012) Quality of Life Outcomes of Antiretroviral Treatment for HIV/AIDS Patients in Vietnam. PLoS ONE ,7(7) , 1-8.
Benjamin H. Balderson , Lou Grothaus , Robert G. Harrison , Katryna McCoy , Christine Mahoney & Sheryl Catz (2013) Chronic illness burden and quality of life in an aging HIV population, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 25:4, 451-458.
CDC.(1997).HIV Prevention case management:Guidance.Seprember 1997.
Choi-Fung Ho, Sheila Twinn and Karis K.F. Cheng (2010). Quality of life constructs of Chinese people living with HIV/AIDS,Psychology, Health & Medicine,15( 2), 210–219.
Cheng-Fang Yen , Jim-Jin Tsai , Po-Liang Lu ,Yen-Hsu Chen , Tun-Chien Chen , Pei-Pei Chen and Tyen-Po Chen (2004) . Quality of life and its correlates in HIV/AIDS male outpatients receiving highly active antiretroviral therapy in Taiwan. Psychiatry and Clinical Neurosciences, 58, 501–506.
C.T. Fang , Y.Y. Cheng , H.M. Hsu , S.J. Twu , K.T. Chen , C.C. Lin , L.Y.L. Huang , M.Y. Chen, J.S. Hwang , J.D. Wang and C.Y. Chuang (2007) . Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy. Q J Med , 100 , 97–105.
Chou, K.L. (2000).Assessing Chinese adolescents’ social support: the multidimensional scale of perceived social support. Personality and Invividual Differences, 28 , 299-307.
Deepika Anand, Seema Puri, Minnie Mathew (2012) Assessment of Quality of Life of HIV-Positive People Receiving ART: An Indian Perspective . Indian J Community Med . 37, 165-169.
Edward M. Gardner, Margaret P. McLees , John F. Steiner ,Carlos del Rio and William J. Burman .(2011). The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV Infection .Clinical Infectious Diseases. 52(6):793-800.
Eklund C, Melin L, Hiltunen A, Borg S.(1994). Detoxification from methadone maintenance treatment in Sweden: Long-term outcome and effects on quality of life and life situation. Int J Addict .29(5):627–645.
Fang CT, Chang YY, Hsu HM (2007) Life expectancy of patients with newlydiagnosed HIV infection in the era of highly active antiretroviral therapy. QJM ,100:97-105.
Holmes ,W.C. & Shea , J.A. (1997). Performance of a new, HIV/AIDS-targeted quality of life (HAT-QoL) instrumentin asymptomatic seropositive individuals. Quality of Life Research , 6, 561-571.
Hornquist JO. (1982). The concept of quality of life. Scand J Soc Med 10,57-61.
Jane da Silva , Karoline Bunn , Rochele F. Bertoni , Oromar A. Neves & Jefferson Traebert. (2013). Quality of life of people living with HIV, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 25:1, 71-76.
Koch, T. (2000). Life quality vs the quality of life assumptions underlying prospective quality of life instruments in health care planning. Social Science & Medicine 51, 8.
Ko, N. Y., Lai, Y. Y., Liu, H. Y., Lee, H. C., Chang, C. M., Lee, N. Y., Ko, W. C. (2012). Impact of the nurse-led case management program with retention in care on mortality among people with HIV-1 infection: a prospective cohort study. Int J Nurs Stud, 49(6), 656-663.
Margalho R, Pereira M, Ouakinin S, Canavarro MC.(2011) Adherence to HAART, quality of life and psychopathological symptoms among HIV/AIDS infected patients. Acta Med Port. 24(2):539-48.
Meei-Horng Yang , Yi-Ming. Chen., Benjamin In-Tian Kuo, Kwua-Yun Wang. (2003). Quality of Life and Related Factors for People Living With HIV/AIDS in Northern Taiwan. Jour nal of Nursing Re search 11(3), 10.
Melanie A. Thompson, Michael J. Mugavero, K. Rivet Amico, Larry W. Chang, Robert Gross, Catherine Orrell, ,Frederick L. Altice .(2012) . Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel. Annals of Internal Medicine 156 :817-833.
Metsch LR, Pereyra M, Messinger S, et al. (2008).HIV transmission risk behaviors
among HIV-infected persons who are successfully linked to care. Clinical Infectious Diseases. 47:577–84.
Ming-Chu Feng , Jui-Ying Feng , Tun-Chieh Chen , Po-Liang Lu , Nai-Ying Ko & Yen-Hsu Chen (2009):Stress, needs, and quality of life of family members caring for adults living with HIV/AIDS in Taiwan, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 21:4, 482-489.
Monica Airoldi, Mauro Zaccarelli, Luca Bisi, Teresa Bini, Andrea Antinori, Cristina Mussini, Francesca Bai, Giancarlo Orofino, Laura Sighinolfi , Andrea Gori ,Fredy Suter, Franco Maggiolo (2011) One-pill once-a-day HAART: a simplification strategy that improves adherence and qualityof life of HIV-infected subjects. Patient Preference and Adherence ,4, 115–125.
Mugavero MJ, Lin HY, Willig JH, et al. (2009). Missed visits and mortality
among patients establishing initial outpatient HIV treatment. Clin Infect Dis 48:248–56.
Nilsson Schonnesson, L. (2002). Psychological and existential issues and quality of life in people living with HIV infection. [Review]. AIDS Care, 14(3), 399-404. doi: 10.1080/09540120220123784
Peter Messeir, G. L., David M. Abramson, Angela AidalaI, Mary Ann Chiasson ,Dorothy Jones Jessop,. (2003). Antiretroviral Therapy and Declining AIDS Mortality in New York City. MEDICAL CARE, 41(4), 10.
Peng-Wei Wang, Hung-ChiWu, Chia-Nan Yen, Yi-Chun Yeh, Kuan-Sheng Chung, Hsun-Cheng Chang, Cheng-Fang Yen. (2012) Change in Quality of Life and Its Predictors in Heroin Users Receiving Methadone Maintenance Treatment in Taiwan:An 18-Month Follow-Up Study .The American Journal of Drug and Alcohol Abuse, 38(3): 213–219.
Pereira M, Canavarro MC.(2012). Quality of life and emotional distress among HIV-positive women during transition to motherhood.Span J Psychol.Nov;15(3):1303-14.
Ping-Chuan Hsiung , Chi-Tai Fang , Chia-Huei Wu , Wang-Huei Sheng , Shing-Chia Chen , Jung-Der Wang &Grace Yao (2011): Validation of the WHOQOL-HIV BREF among HIV-infected patients in Taiwan, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 23:8, 1035-1042.
Raj R, Sreenivas V, Mehta M, Gupta S.(2010) .Health-related quality of life in Indian patients with three viral sexually transmitted infections: herpes simplex virus-2, genital human papilloma virus and HIV. Sex Transm Infect. Apr;87(3):216-20.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.
Sarah Abboud , Samar Noureddine , Huda Abu-Saad Huijer , Jocelyn DeJong & Jacques Mokhbat (2010) Quality of life in people living with HIV/AIDS in Lebanon, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV,22:6, 687-696.
S.M. Skevington , S. Norweg , M. Standage & The WHOQOL HIV Group (2010) Predicting quality of life for people living with HIV: international evidence from seven cultures, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 22:5, 614-622.
S.M. Skevington (2012) Is quality of life poorer for older adults with HIV/AIDS? International evidence using the WHOQOL-HIV, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 24:10, 1219-1225.
Sonsel,G. E. (1989).Casemanagement in a community based AIDS agency. Quality Review Bulletin, 15(1), 31-36.
Sushil Yadav. (2010) .Perceived social support, hope, and quality of life of persons living with HIV/AIDS: a case study from Nepal ,Qual Life Res19:157–166
Suniti Solomon, Ashita Batavia, Kartik K Venkatesh, Lisanne Brown, Praneeta Verma, Anitha J. Cecelia, Celine Daly, Vaishali S Mahendra, N. Kumarasamy, and Kenneth H. Mayer. (2009). Longitudinal Quality-of-Life Study of HIV-infected persons in South India: the case for comprehensive clinical care and support services. AIDS Education and Prevention, 21(2), 104–112.
Thomas P. Giordano, Allen L. Gifford, A. Clinton White, Jr.,Maria E.Suarez-Almazor, Linda Rabeneck, Christine Hartman, Lisa I. Backus, Larry A. Mole and Robert O. Morgan. (2007) .Retention in Care: A Challenge to Survival with HIV Infection. Clinical Infectious Diseases, 44:1493–1499.
Tominari S, Nakakura T, Yasuo T, Yamanaka K, Takahashi Y, et al. (2013) Implementation of Mental Health Service Has an Impact on Retention
in HIV Care: A Nested Case-Control Study in a Japanese HIV Care Facility. PLoS ONE .8(7): e69603,1-6.
Whoqol Hiv Group (2004): WHOQOL-HIV for quality of life assessment among
people living with HIV and AIDS: results from the field test, AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV, 16:7, 882-889.
William C. Holmes ,Warren B. Bilker,Hao Wang,Jennifer Chapman and Robert Gross.(2007).HIV/AIDS-Specific Quality of Life and Adherence to Antiretroviral Therapy Over Time .Jounal Acquir Immune Defic Syndr (46),323-327.
Wen-Li Hou, Chia-En Chen, Hsiao-Ying Liu, Yi-Yin Lai, Hsin-Chun Lee, Nan-Yao Lee, Chia-Ming Chang, Po-Lin Chen, Wen-Chien Ko, Bih-Ching Shu & Nai-Ying Ko (2014) Mediating effects of social support on depression and quality of life among patients with HIV infection in Taiwan, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 26:8,996-1003.
Yang, C. H., Huang, Y. F., Hsiao, C. F., Yeh, Y. L., Liou, H. R., Hung, C. C., & Yang, S. Y. (2008). Trends of mortality and causes of death among HIV-infected patients in Taiwan, 1984-2005. HIV Med, 9(7), 535-543.
Yvonne S. Handajani , Zubairi Djoerban , Hendry Irawan (2012) Quality of Life People Living with HIV/AIDS: Outpatient in Kramat 128 Hospital Jakarta . The Indonesian Journal of Internal Medicine , (44) ,310-316.
行政院衛生署疾病管制局．法定傳染病統計資料．後天免疫缺乏症候群．2012年3月26取自http://www.cdc.gov.tw/public/Data/23216215571.pdf
方啟泰、王榮德、張郁瑩(2002)．九十一年度科技研究發展計畫．愛滋病療成本效性分析：方法之發展與應用．行政院衛生署疾病管制局專題研究成果報告（報告編號：DOH91-DC-1056），未出版。
行政院衛生署疾病管制局．法定傳染病統計資料．後天免疫缺乏症候群．2012年3月26取自http://www.cdc.gov.tw/public/Data/23216215571.pdf

行政院衛生署疾病管制局(2009)．傳染病病例定義暨防疫檢體採檢送驗事項．後天免疫缺乏症候群。
行政院衛生署疾病管制局(2012)．愛滋病檢驗與治療指引．2013年7月17日取自
http://www.cdc.gov.tw/uploads/files/201304/6ae23433-e908-47af-9953-1a9a29856519.pdf
姚開屏(2006)．台灣版世界衛生組織生活品質問卷之發展與應用．臺灣醫學，6 (2），193-200。
張雅筑、陳建和（2010）．人類免疫缺乏病毒男性感染者壓力、休閒因應策略及生活品質關係之研究．戶外遊憩研究，23(4)，51-77。
盧瑞芬、曾旭民、蘇益堅(2002)．國人生活品質評量(Ⅰ)：SF-36台灣版的發展及心理計量特質分析，台灣衛誌，22(6)，501-511.
國家衛生研究院(2009) 國民健康訪問調查: EQ-5D之效度分析-2009年國民健康訪問暨藥物濫用調查結果．于勝宗、張新儀、姚開屏、林宇旋、洪百薰http://nhis.nhri.org.tw/files/2009NHIS_Brief_5.pdf.