Introduction
AIDS is a deadly disease that affects the human immune system and makes infected patients vulnerable to opportunistic infections and many other diseases such as tuberculosis, malaria, and cancer [1]. By 2017, 36.9 million Human Immunodeficiency Virus (HIV) patients worldwide were identified as positive, of which 1.8 million were newly infected [2].
The mortality related to HIV/AIDS is higher in African countries and South and Southeast Asia than in European countries [3]. According to the World Health Organization, in 2017, 60,000 HIV-infected patients lived in Iran [4].
Understanding the problems or needs of HIV-positive patients to provide direct care will improve their Quality of Life (QoL) [5].
In Iran, few studies have been conducted on the QoL of HIV-positive patients [1, 6, 7, 8]. In this study, we have studied the vacuum induced by recognizing the QoL of HIV patients. This study aimed to assess the QoL among HIV-positive patients registered in Markazi Province in 2019-2020.
Material and Methods
This study was a cross-sectional design (descriptive-analytical) that was conducted in 2019-2020 in Markazi Province. The participants in this study were among those whose HIV infection was confirmed by laboratory tests. The study population consists of identified individuals registered at Arak City and Saveh City Universities of Medical Sciences. To conduct the study convenience sampling method was used. One of the questionnaires used in this study is the demographic questionnaire, which includes data on date of birth, gender, transfer method, education, and habitat location. Data on time elapsed from the disease diagnosis and the disease transmission method were also collected from the participants. 
To determine the QoL in HIV patients from the questionnaire summarized Quality of Life Questionnaire of the World Health Organization for HIV (WHOQOL HIV‑BREF) designed in English, developed by the World Health Organization (WHO) in 1998 [9]. The questionnaire scoring was such that the highest score was assigned to the highest state of health. The overall QoL is the sum of the scores obtained by each person from each of the domains, in which case a score in the range of 24 to 120 was obtained. The Backward method used linear regression to determine the factors affecting the QoL related to HIV. A  P less than 0.05 was considered significant. The analysis was performed in STATA 12.0 software.
3. Results
In total, 126 people with HIV were included in the study. Men accounted for 66.7% of the participants. The mean age of the participants was 4.4±2.1 years. The most common method of HIV transmission was injecting drugs use (51.2%, n=63). Among the participants, 46% (n=58) were primary and illiterate education. Hepatitis B or C, alcohol use, smoking, hookah, and prison history in 36.5% (n=46), 51.6% (n=65), 64.3% (n=81), 54% (n=68), respectively. The mean time from HIV diagnosis to completion of the questionnaire was 79.7±55.6 months.
The mean score of the questionnaire domains was 14.4 in physical, 11.7 in psychological, 13.3 in independence, 11.2 in social, 10.8 in the environment, 13.2 in spiritual domains, and 12.1 in total QoL.
In the final multivariate linear regression model, variables such as gender, socioeconomic status, alcohol consumption, education, and imprisonment history explained 49% of the variance changes in total QoL. This model obtained a significant regression equation (P=0.001, F=11.20 (102, 9)). Men (P=0.005, regression coefficient 1.47), poor socioeconomic status (P=0.002, regression coefficient=1.77), moderate socioeconomic status (P=0.001, regression coefficient=2.59), rich socioeconomic status (P=0.001, 2.87=regression coefficient) and more rich socioeconomic status (P=0.001, regression coefficient 3.66) and history of not being imprisoned (P=0.011, regression coefficient=1.36), Significantly predicted higher scores of total QoL.
Discussion
The results of this study showed that the total score of QoL and in each of its domains in people with HIV in Markazi Province has an intermediate status. Factors related to the increase in the total score of QoL include male gender, higher socioeconomic status, and a history of not being imprisoned.
One of the reasons for the low score of QoL among women compared to men is cohabitation in HIV-infected people and the significant impact of socioeconomic status on QoL. Future studies suggest focusing more on this gender difference in QoL scores and the main reasons and strategies to improve their QoL.
This study has some limitations. The small number of samples in this study may affect the results. However, the present study all individuals covered by the health care system tried to include. On the other hand, the present study’s data, like all related studies, were based on patients’ self-report data, which can be a source of information bias.
Physicians and other health care workers should be aware of the factors affecting the QoL among these people, and it is recommended that the assessment of QoL in these patients be added to their care protocols to determine the course of treatment and HIV-related health status in this group. 
It was concluded that the QoL among people living with HIV was relatively intermediate in Arak. Some factors should be considered with more attention to identifying levels of demographic categories to increase QoL among these groups, to enable them to deal more effectively with the pain related to HIV as their underlying illness.

Ethical Considerations
Compliance with ethical guidelines
This study was approved and conducted by the ethics committee of Arak University of Medical Sciences (IR.ARAKMU.REC.1398.008).

Funding
This research is sponsored by Arak University of Medical Sciences with the number
Approved 3300 has been implemented.

Authors' contributions
Conceptualization, research and sampling methods, data analysis, text writing and review: Rahmatollah Moradzadeh and Maryam Zamanian; Sampling, text writing and review: Iman Navidi.

Conflicts of interest
There is no conflict of interest.



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