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One-Year Sequelae and Quality of Life in Adults with Meningococcal Meningitis: Lessons from the COMBAT Multicentre Prospective Study. Adv Ther 2022; 39:3031-3041. [PMID: 35484469 PMCID: PMC9123035 DOI: 10.1007/s12325-022-02149-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION COMBAT is a prospective, multicentre cohort study that enrolled consecutive adults with community-acquired bacterial meningitis (CABM) in 69 participating centres in France between February 2013 and July 2015 and followed them for 1 year. METHODS Patients aged at least 18 years old, hospitalised with CABM were followed during their hospitalisation and then contacted by phone 12 months after enrolment. Here we present the prevalence of sequelae at 12 months in a subgroup of patients with meningococcal meningitis. RESULTS Five of the 111 patients with meningococcal meningitis died during initial hospitalisation and two died between discharge and 12 months, leaving 104 patients alive 1 year after enrolment, 71 of whom provided 12-month follow-up data. The median age was 30.0 years and 54.1% of the patients had no identified risk factor for meningitis. More than 30% reported persistent headache, more than 40% were not satisfied with their sleep and 10% had concentration difficulties. Hearing loss was present in about 15% of the patients and more than 30% had depressive symptoms. About 13% of the patients with a previous professional activity had not resumed work. On the SF-12 Health Survey, almost 50% and 30% had physical component or mental component scores lower than the 25th percentile of the score distribution in the French general population. There was a non-significant improvement in the patients' disability scores from hospital discharge to 12 months (p = 0.16), but about 10% of the patients had residual disability. CONCLUSIONS Although most patients in our cohort survive meningococcal meningitis, the long-term burden is substantial and therefore it is important to ensure a prolonged follow-up of survivors and to promote preventive strategies, including vaccination. TRIAL REGISTRATION ClinicalTrial.Gov identification number NCT01730690.
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Eloy P, Tardivon C, Martin-Blondel G, Isnard M, Turnier PLE, Marechal MLE, Cabié A, Launay O, Tattevin P, Senneville E, Ansart S, Goehringer F, Chirouze C, Bousson L, Laouénan C, Etienne M, Nguyen D, Ghosn J, Duval X. Severity of self-reported symptoms and psychological burden 6-months after hospital admission for COVID-19: a prospective cohort study. Int J Infect Dis 2021; 112:247-253. [PMID: 34517049 PMCID: PMC8432979 DOI: 10.1016/j.ijid.2021.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives Few studies have reported clinical COVID-19 sequelae six months (M6) after hospital discharge, but none has studied symptom severity. Methods Prevalence and severity of 7 symptoms were estimated until M6 using the self-administered influenza severity scale in COVID-19 hospitalized patients enrolled in the French COVID cohort. Factors associated with severity were assessed by logistic regression. Anxiety, depression and health-related quality of life (HRQL) were also assessed. Results At M6, among the 324 patients (median age 61 years, 63% men, 19% admitted to intensive care during the acute phase), 187/324 (58%) reported at least one symptom, mostly fatigue (47%) and myalgia (23%). Symptom severity was scored, at most, mild in 125 (67%), moderate in 44 (23%) and severe in 18 (10%). Female gender was the sole factor associated with moderate/severe symptom reporting (OR = 1.98, 95%CI=1.13-3.47). Among the 225 patients with psychological assessment, 24 (11%) had anxiety, 18 (8%) depressive symptoms, and their physical HRQL was significantly poorer than the general population (p=0.0005). Conclusion Even if 58% of patients reported ≥1 symptom at M6, less than 7% rated any symptom as severe. Assessing symptoms severity could be helpful to identify patients requiring appropriate medical care. Women may require special attention.
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Affiliation(s)
- Philippine Eloy
- AP-HP, Hôpital Bichat, Département Epidémiologie Biostatistiques et Recherche Clinique, F-75018 Paris, France; INSERM, Centre d'Investigations cliniques-Epidémiologie Clinique 1425, Hôpital Bichat, F-75018 Paris, France.
| | - Coralie Tardivon
- AP-HP, Hôpital Bichat, Département Epidémiologie Biostatistiques et Recherche Clinique, F-75018 Paris, France; INSERM, Centre d'Investigations cliniques-Epidémiologie Clinique 1425, Hôpital Bichat, F-75018 Paris, France
| | | | - Margaux Isnard
- Service de Maladies Infectieuses et Médecine Interne, CH Métropole Savoie
| | - Paul LE Turnier
- Department of Infectious Diseases, Hotel-Dieu Hospital - INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Marion LE Marechal
- CHU Grenoble Rhône Alpes, Service de Maladies Infectieuses et Médecine Tropicale, F-38000 Grenoble, France
| | - André Cabié
- Inserm CIC 1424, Université des Antilles EA 7524, Service de maladies infectieuses et tropicales, CHU de Martinique, F-97200 Fort-de-France, France
| | - Odile Launay
- Inserm CIC 1417, Faculté de Médecine Paris Descartes, Univ Paris, AP-HP, Hôpital Cochin, Paris, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, University Rennes-1, Rennes, France
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, 59200 Tourcoing, France
| | - Séverine Ansart
- Tropical and Infection Diseases Unit, CHRU de Brest, F-29200 Brest, France
| | - François Goehringer
- Service de Maladies Infectieuses et Tropicales, Centre Régional Universitaire de Nancy, Hôpitaux de Brabois, Rue du Morvan, 54511 Vandoeuvre Lés Nancy, France
| | - Catherine Chirouze
- CHU Besançon, Service de Maladie Infectieuses et Tropicales, F-25000, Besançon, France
| | - Laurane Bousson
- INSERM, Centre d'Investigations cliniques-Epidémiologie Clinique 1425, Hôpital Bichat, F-75018 Paris, France
| | - Cédric Laouénan
- AP-HP, Hôpital Bichat, Département Epidémiologie Biostatistiques et Recherche Clinique, F-75018 Paris, France; INSERM, Centre d'Investigations cliniques-Epidémiologie Clinique 1425, Hôpital Bichat, F-75018 Paris, France; Université de Paris, INSERM, IAME UMR 1137, Paris, France
| | - Manuel Etienne
- CHU Rouen, Service des Maladies Infectieuses et Tropicales, F-76000 Rouen, France
| | - Duc Nguyen
- Department of Infectious and Tropical Diseases, CHU de Bordeaux, Bordeaux, France
| | - Jade Ghosn
- Université de Paris, INSERM, IAME UMR 1137, Paris, France; AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, Paris, France
| | - Xavier Duval
- Université de Paris, INSERM, IAME UMR 1137, Paris, France; AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, F-75018 Paris, France
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Goh OQ, Kroon E, Sacdalan C, Chan P, Crowell TA, Kanaprach R, Anonworanich J, Vasan S, Wu AW, Phanuphak N, Colby DJ. Persons living with HIV treated in acute HIV infection report good health-related quality of life in Thailand. AIDS Care 2021; 34:949-956. [PMID: 34191663 DOI: 10.1080/09540121.2021.1944596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The health-related quality of life (HRQoL) among persons living with HIV (PLWHA) who initiate ART during acute HIV infection (AHI) is not well studied. Participants in the SEARCH010/RV254 cohort initiated ART during AHI. They completed the Thai version of the World Health Organisation Quality of Life instrument-BREF (WHOQOL-BREF) and Patient Health Questionnaire-9 (PHQ-9) prior to ART initiation and 24 weeks later. Of 452 participants, 406 (90%) completed the WHOQOL-BREF. The median age was 26 years (IQR 22-31), and 98% were men. All WHOQOL-BREF domains demonstrated good internal consistency (Cronbach's alpha >0.70). Confirmatory factor analysis validated the WHOQOL-BREF model. 90% of Pearson correlations between domain scores and general facet items were >0.50. HRQoL in all domains was worse among those with at least moderately severe depression (PHQ-9 ≥ 10) (p<0.0001), supporting discriminant validity. At 24 weeks, there was an improvement of scores in all domains (physical, psychological, social, and environmental) and general facet items (p<0.0001), and the range of mean domain scores was 14.7-15.6 (SD 2.3-2.8). The majority of participants (58-63%) had improved HRQoL in the physical, psychological and environmental domains. It is concluded that HRQoL improves 6 months after initiation of ART in AHI, suggesting a benefit of early ART initiation.
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Affiliation(s)
- Orlanda Q Goh
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,SingHealth DukeNUS Medicine Academic Clinical Programme, Singapore
| | - Eugène Kroon
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Carlo Sacdalan
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Phillip Chan
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | - Jintanat Anonworanich
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
| | - Sandhya Vasan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Donn J Colby
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
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Sabranski M, Erdbeer G, Sonntag I, Stoehr A, Horst HA, Plettenberg A, Lebherz L, Stellbrink HJ, Hoffmann C. Physical and mental health in HIV-infected patients with virological success and long-term exposure to antiretroviral therapy. AIDS Care 2020; 33:453-461. [PMID: 32106695 DOI: 10.1080/09540121.2020.1733466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In people living with HIV (PLWH), a decade-long antiretroviral therapy (ART) poses new challenges regarding physical and mental health. The aim of this cross-sectional study is to investigate the health-related quality of life (HRQOL) in adult HIV-infected patients with viral suppression and an ART exposure for at least 5 years in three German HIV centers. Patients were evaluated by the ACTG Augmented Symptoms Distress Module (ASDM) and the SF-12 Health Survey. Among 894 patients, symptom-related distress was highly prevalent. The most common symptoms were fatigue, insomnia, sadness and depression, sexual dysfunction, and changes in body appearance. In the multivariate analysis, ART duration, age and depression were significantly associated with a higher overall symptom summary score. Self-reported mean SF-12 scores were lower for mental health and younger patients compared to the standard random sample of a healthy German population. Depression and occupational status were significantly related to a lower physical component summary score, by contrast older age was associated with higher scores in the mental component summary, implying more favorable mental health status. In this large group of PLWH, the degree of symptom-related distress was high. Mental and physical health should be considered an integral part of ongoing HIV care.
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Affiliation(s)
| | - Gesa Erdbeer
- Department of Medicine II, University of Schleswig-Holstein, Campus Kiel, Germany
| | - Ina Sonntag
- Department of Medicine II, University of Schleswig-Holstein, Campus Kiel, Germany
| | - Albrecht Stoehr
- IFI Institute for Interdisciplinary Medicine, Hamburg, Germany
| | - Heinz-August Horst
- Department of Medicine II, University of Schleswig-Holstein, Campus Kiel, Germany
| | | | - Lisa Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christian Hoffmann
- ICH Study Center, Hamburg, Germany.,Department of Medicine II, University of Schleswig-Holstein, Campus Kiel, Germany
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Tubiana S, Varon E, Biron C, Ploy MC, Mourvillier B, Taha MK, Revest M, Poyart C, Martin-Blondel G, Lecuit M, Cua E, Pasquet B, Preau M, Hoen B, Duval X. Community-acquired bacterial meningitis in adults: in-hospital prognosis, long-term disability and determinants of outcome in a multicentre prospective cohort. Clin Microbiol Infect 2020; 26:1192-1200. [PMID: 31927117 DOI: 10.1016/j.cmi.2019.12.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/24/2019] [Accepted: 12/29/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify factors associated with unfavourable in-hospital outcome (death or disability) in adults with community-acquired bacterial meningitis (CABM). METHODS In a prospective multicentre cohort study (COMBAT; February 2013 to July 2015), all consecutive cases of CABM in the 69 participating centres in France were enrolled and followed up for 12 months. Factors associated with unfavourable outcome were identified by logistic regression and long-term disability was analysed. RESULTS Among the 533 individuals enrolled, (Streptococcus pneumoniae 53.8% (280/520 isolates identified), Neisseria meningitidis 21.3% (111/520), others 24.9% (129/520)), case fatality rate was 16.9% (90/533) and unfavourable outcome occurred in 45.0% (225/500). Factors independently associated with unfavourable outcome were: age >70 years (adjusted odds ratio (aOR) 4.64; 95% CI 1.93-11.15), male gender (aOR 2.11; 95% CI 1.25-3.57), chronic renal failure (aOR 6.65; 95% CI 1.57-28.12), purpura fulminans (aOR 4.37; 95% CI 1.38-13.81), localized neurological signs (aOR 3.72; 95% CI 2.29-6.05), disseminated intravascular coagulation (aOR 3.19; 95% CI 1.16-8.79), cerebrospinal fluid (CSF) white-cell count <1500 cells/μL (aOR 2.40; 95% CI 1.42-4.03), CSF glucose concentration (0.1-2.5 g/L: aOR 1.92; 95% CI 1.01-3.67; <0.1 g/L: aOR 2.24; 95% CI 1.01-4.97), elevated CSF protein concentration (aOR 1.09; 95% CI 1.03-1.17), time interval between hospitalization and lumbar puncture >1 day (aOR 2.94; 95% CI 1.32-6.54), and S. pneumoniae meningitis (aOR 4.99; 95% CI 1.98-12.56), or meningitis other than N. meningitidis (aOR 4.54; 95% CI 1.68-12.27). At 12 months, 26.7% (74/277) had hearing loss, 32.8% (87/265) depressive symptoms, 31.0% (86/277) persistent headache, and 53.4% had a physical health-related quality of life (142/266) <25th centile of the distribution of the score in the general French population (p < 0.0001). CONCLUSIONS The burden of CABM (death, disability, depression, impaired quality of life and hearing loss) is high. Identification of cases from the first symptoms may improve prognosis. CLINICALTRIAL Gov identification number: NCT01730690.
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Affiliation(s)
- S Tubiana
- Paris University, IAME, INSERM, Paris, France; Inserm Clinical Investigation Centre 1425, Paris, France.
| | - E Varon
- National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Biron
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
| | - M-C Ploy
- CHU Limoges, Observatoires Régionaux Du Pneumocoque, Limoges, France
| | - B Mourvillier
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris University, Paris, France
| | - M-K Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France
| | - M Revest
- Infectious Diseases and Intensive Care Unit, INSERM U 1230, CHU Rennes, Rennes University, Rennes, France
| | - C Poyart
- Department of Bacteriology, University Hospitals Paris Centre-Cochin, French National Centre for Streptococci, APHP, France
| | - G Martin-Blondel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, France; INSERM, UMR1043, Toulouse, France
| | - M Lecuit
- Institut Pasteur, Biology of Infection Unit, INSERM U1117, National Reference Centre and WHO Collaborating Center for Listeria, Paris, France; Université de Paris, Hôpital Universitaire Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Institut Imagine, APHP, Paris, France
| | - E Cua
- Infectious Diseases Department, CHU Nice, France
| | - B Pasquet
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Unité de Recherche Clinique Paris Nord, Paris, France
| | - M Preau
- GRePS, Lyon 2 University, Lyon, France
| | - B Hoen
- CHU de Nancy, Hôpitaux de Brabois, Service de Maladies Infectieuses et Tropicales, Vandœuvre-lès-Nancy, France
| | - X Duval
- Paris University, IAME, INSERM, Paris, France; Inserm Clinical Investigation Centre 1425, Paris, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
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6
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Torres TS, Harrison LJ, La Rosa AM, Cardoso SW, Zheng L, Ngongondo M, Some F, Lalloo UG, Mwelase T, Collier AC, Hughes MD. Quality of life improvement in resource-limited settings after one year of second-line antiretroviral therapy use among adult men and women. AIDS 2018; 32:583-593. [PMID: 29334547 PMCID: PMC5832593 DOI: 10.1097/qad.0000000000001738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated improvement of quality of life (QoL) after 1 year of second-line antiretroviral therapy (ART) use in resource-limited settings (RLS) among adult men and women, comparing two randomized treatment arms. DESIGN The AIDS Clinical Trial Group A5273 was a randomized clinical trial of second-line ART comparing lopinavir/ritonavir (LPV/r) + raltegravir with LPV/r + nucleos(t)ide reverse transcriptase inhibitors (NRTIs) in participants failing a non-NRTI-containing regimen at 15 sites in nine RLS. Participants completed the AIDS Clinical Trial Group short-form-21 which has eight QoL domains with a standard score ranging from 0 (worst) to 100 (best). METHODS Differences in QoL by randomized arm, as well as by demographic and clinical variables, were evaluated by regression models for baseline and week 48 QoL scores fitted using the generalized estimating equations method. RESULTS A total of 512 individuals (49% men, median age 39 years) were included. A total of 512 and 492 participants had QoL assessments at baseline and week 48, respectively. QoL improved significantly from baseline to week 48 (P < 0.001 for all domains). There was no significant difference between treatment arms for any domain. Individuals with higher viral load and lower CD4 cell count at baseline had lower mean QoL at baseline but larger improvements such that mean QoL was similar at week 48. CONCLUSION Improvements in QoL were similar after starting second-line ART of LPV/r combined with either raltegravir or NRTIs in RLS. QoL scores at baseline were lower among participants with worse disease status prior to starting second-line, but after 1 year similar QoL scores were achieved.
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Affiliation(s)
- Thiago S Torres
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- LAPCLIN-AIDS, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Linda J Harrison
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Sandra W Cardoso
- LAPCLIN-AIDS, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Lu Zheng
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - McNeil Ngongondo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- UNC Project, Lilongwe, Malawi
| | - Fatma Some
- AMPATH at Moi University Teaching Hospital, Eldoret, Kenya
| | | | - Thando Mwelase
- Wits Health Consortium Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael D Hughes
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Alemayehu M, Wubshet M, Mesfin N, Gebayehu A. Effect of Health Care on Quality of Life among Human Immunodeficiency Virus Infected Adults With and Without Visceral Leishmaniasis in northwest Ethiopia: A Longitudinal Follow-Up Study. Am J Trop Med Hyg 2018; 98:747-752. [PMID: 29363454 DOI: 10.4269/ajtmh.17-0458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
There has been a scarcity of data on the effect of health care on the quality of life (QoL) of human immunodeficiency virus (HIV)- and visceral leishmaniasis (VL)- coinfected patients over time. We sought to assess the change that health care brings about in the QoL of HIV patients with and without VL and its predictors in 6 months. A total of 465 HIV patients without VL and 125 HIV-VL-coinfected patients were enrolled in the longitudinal follow-up study from October 2015 to September 2016. Data on QoL at baseline and in 6 months were collected by trained nurses through face-to-face interviews using a short Amharic version of World Health Organization QoL instrument for HIV clients. Multiple linear regressions were used to assess the predictors of health-related QoL. There was an improvement in all of the domains of QoL at the sixth month follow-up compared with the baseline for both groups of patients (P < 0.001). Lack of social support and income were associated with the low improvement in QoL in most of the domains in both groups. Compared with patients having severe acute malnutrition, patients having moderate acute malnutrition and normal nutritional status were better in most of the QoL domains in both groups of patients. Both antiretroviral and anti-VL treatments showed improvement in all dimensions of QoL. Income, social support, and nutritional status were the predictors for most of the QoL domains.
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Affiliation(s)
- Mekuriaw Alemayehu
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mamo Wubshet
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nebiyu Mesfin
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebayehu
- Department of Reproductive Health, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Torres TS, Harrison LJ, La Rosa AM, Lavenberg JA, Zheng L, Safren SA, Ngongondo M, Poongulali S, Matoga M, Samaneka W, Collier AC, Hughes MD. Quality of life among HIV-infected individuals failing first-line antiretroviral therapy in resource-limited settings. AIDS Care 2018; 30:954-962. [PMID: 29343078 DOI: 10.1080/09540121.2018.1427207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated health-related quality of life (QoL) in HIV infection participants with virologic failure (VF) on first-line antiretroviral therapy (ART) in 9 resource-limited settings (RLS). ACTG SF-21 was completed by 512 participants at A5273 study entry; 8 domains assessed: general health perceptions (GHP), physical functioning (PF), role functioning (RF), social functioning (SF), cognitive functioning (CF), pain (P), mental health (MH), and energy/fatigue (E/F); each was scored between 0 (worst) to 100 (best). Mean QoL scores ranged from 67 (GHP) to 91 (PF, SF, CF). QoL varied by country; high VL and low CD4 were associated with worse QoL in most domains, except RF (VL only), SF (CD4 only) and CF (neither). Number of comorbidities, BMI and history of AIDS were associated with some domains. Relationships between QoL and VL varied among countries for all domains. The association of worse disease status with worse QoL may reflect low QoL when ART was initiated and/or deterioration associated with VF.
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Affiliation(s)
- Thiago S Torres
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,b LAPCLIN-AIDS, Instituto Nacional de Infectologia Evandro Chagas (INI-FIOCRUZ) , Rio de Janeiro , Brazil
| | - Linda J Harrison
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | | | - Jeffrey A Lavenberg
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Lu Zheng
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Steven A Safren
- d Department of Psychology , University of Miami , Miami , FL , USA
| | - McNeil Ngongondo
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,e UNC Project Lilongwe , Lilongwe , Malawi
| | | | | | - Wadzanai Samaneka
- g Department of Medicine , University of Zimbabwe-University of California Collaborative Research Programme , Harare , Zimbabwe
| | - Ann C Collier
- h Department of Medicine , University of Washington , Seattle , WA , USA ; for AIDS Clinical Trials Group (ACTG) A5273 Study Group
| | - Michael D Hughes
- a Center for Biostatistics in AIDS Research , Harvard T. H. Chan School of Public Health , Boston , MA , USA
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9
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Health-related quality of life of people with HIV: an assessment of patient related factors and comparison with other chronic diseases. AIDS 2018; 32:103-112. [PMID: 29112062 DOI: 10.1097/qad.0000000000001672] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The health-related quality of life (HRQOL) of people with HIV is lower than in the general population, but it is unknown how it compares with that of persons with other chronic medical conditions. We compared HRQOL in HIV with HRQOL in diabetes mellitus type 1, diabetes mellitus type 2 and rheumatoid arthritis (RA). In addition, we investigated factors associated with HRQOL in HIV. DESIGN Cross-sectional study. METHODS HRQOL was measured with the Medical Outcomes Study Short Form 36-item Health Survey in a nationwide sample of people with HIV in care in the Netherlands and on combination antiretroviral therapy for at least 6 months. We added data from studies in diabetes mellitus types 1 and 2, and RA. Logistic regression analysis was used to examine: the association between disease group and a poor HRQOL, and patient factors associated with poor HRQOL in HIV. RESULTS The odds of a poor physical HRQOL in the HIV group were comparable with the odds in diabetes mellitus types 1 and 2, but lower than in RA patients. The odds of a poor mental HRQOL in HIV were higher than in the other groups. In HIV, a history of AIDS, longer duration of combination antiretroviral therapy and severe comorbidity were associated with a poor physical HRQOL. Sub-Saharan African descent and CD4 cell count of less than 350 cells/μl were associated with poor mental HRQOL. CONCLUSION People with HIV were more likely to have a poor mental HRQOL than patients with other chronic conditions. Addressing mental health should be an integral part of outpatient HIV care.
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Murthy VS, Nayak AS, Joshi MK, Ninawe K. A study of neuropsychological profile of human immunodeficiency virus-positive children and adolescents on antiretroviral therapy. Indian J Psychiatry 2018; 60:114-120. [PMID: 29736073 PMCID: PMC5914239 DOI: 10.4103/psychiatry.indianjpsychiatry_200_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS The aim is to study the neuropsychological and functional profile of children and adolescents with human immunodeficiency virus (HIV) infection on antiretroviral therapy (ART) and the association between the neuropsychological status and medical illness variables, treatment variables, and functional status in the cases of the sample and compare with normal controls. MATERIALS AND METHODS Forty-two HIV-positive children and adolescents on ART were evaluated and compared with 40 matched controls not known to be HIV-positive. The tools used were the Wechsler Intelligence Scale for Children-III R for neuropsychological evaluation, the Brief Impairment Scale to assess functional impairment, and a semi-structured questionnaire to obtain other relevant details. RESULTS There were significant differences between the verbal, performance intelligence quotients (IQs), global IQ score, and several individual subtests between cases and controls. The HIV group was also found to have a significant functional impairment. CONCLUSION Our findings show that HIV infection is associated with significant cognitive and functional impairment. The role of ART in these impairments requires further study. Such understanding can help to introduce wholesome and relatively safer management strategies for youngsters with HIV infection and improve their quality of life.
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Affiliation(s)
- Vasantmeghna S Murthy
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Ajita S Nayak
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Minal K Joshi
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Kaneenica Ninawe
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Alemayehu M, Wubshet M, Mesfin N, Tamiru A, Gebayehu A. Health-related quality of life of HIV infected adults with and without Visceral Leishmaniasis in Northwest Ethiopia. Health Qual Life Outcomes 2017; 15:65. [PMID: 28851361 PMCID: PMC5576231 DOI: 10.1186/s12955-017-0636-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an important outcome measure among HIV infected patients receiving antiretroviral therapy (ART). When HIV infected patients coinfected with Visceral Leishmaniasis (VL) the problem become severe because VL accelerates HIV replication and disease progression. The impact of VL on the quality of life of HIV infected patients has not been studied. In this study in Ethiopia, we compared the quality of life of HIV infected patients with and without VL. METHODS A cross-sectional study was conducted from October 2015 to September 2016 in selected health centers and hospitals, in Northwest Ethiopia. Data on quality of life was collected by trained nurses. The instrument used to collect the data was the short Amharic version of the World Health Organization Quality of Life for HIV clients (WHOQoL-HIV). Depression was assessed using the validated version of Kessler scale. Data was entered and analyzed using SPSS version 20. Descriptive statistics, bivariate and multivariate linear regression model was used to summarize the results. RESULTS A total of 590 study participants were included in the study with response rate of 95%. Of the 590 patients included in our study 125 (21%) were HIV-VL coinfection. HIV-VL coinfected patients had a lower quality of life in all the domains as compared to HIV patients without VL. Depression was consistently and strongly associated with all the quality of life domains of both groups. Also, in HIV infected patients a longer duration in ART was associated with higher HRQoL domains except for the spiritual and level of independence domains. With regard to HIV-VL coinfected patients, a longer duration in ART was associated with psychological, spiritual and level of independence domains of HRQoL. Demographics, clinical, and treatment characteristics resulted few significant associations with HRQoL domains of both groups. CONCLUSION HIV-VL coinfected patients had a poor quality of life in all the domains of the WHOQoL-HIV instrument. Depression, duration of ART and education were strongly associated with the quality of life. Depression should be targeted for intervention to improve the quality of life.
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Affiliation(s)
- Mekuriaw Alemayehu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box - 196, Gondar, Ethiopia.
| | - Mamo Wubshet
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nebiyu Mesfin
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aschalew Tamiru
- Leishmaniasis Research and Treatment Center, College of Medicine and Health Sciences, University of Gondar, P. O. Box - 196, Gondar, Ethiopia
| | - Abebaw Gebayehu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box - 196, Gondar, Ethiopia
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Emuren L, Welles S, Evans AA, Polansky M, Okulicz JF, Macalino G, Agan BK. Health-related quality of life among military HIV patients on antiretroviral therapy. PLoS One 2017; 12:e0178953. [PMID: 28591161 PMCID: PMC5462393 DOI: 10.1371/journal.pone.0178953] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/22/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The aims of this study were: (i) to determine the factors associated with HRQOL at baseline in our cohort, and (ii) to evaluate if there are differences in baseline HRQOL measures by antiretroviral treatment. METHODS The Short Form 36 (SF-36) was administered between 2006 and 2010 among members of the United States HIV Natural History Study cohort (NHS), and participants who completed the SF-36 were included in the study. Physical component summary (PCS) and mental component summary (MCS) scores were computed based on standard algorithms. Multivariate linear regression models were constructed for PCS and MCS to estimate the association between selected variables and HRQOL scores. RESULTS Antiretroviral therapy (ART) was not independently associated with HRQOL scores. Factors associated with PCS were CD4+ count < 200 cells/mm3 (β = -5.84, 95% CI: -7.63, -4.06), mental comorbidity (β = -2.82, 95% CI: -3.79, -1.85), medical comorbidity (β = -2.51, 95% CI: -3.75, -1.27), AIDS diagnosis (β = -2.38, 95% CI: -3.79, -0.98). Others were gender, military rank, marital status, and age. Factors independently associated with MCS were CD4+ count < 200 cells/mm3 (β = -1.93, 95% CI: -3.85, -0.02), mental comorbidity (β = -6.25, 95% CI: -7.25, -5.25), age (β = 0.37, 95% CI: 0.14, 0.60), and being African American (β = 1.55, 95% CI: 0.63, 2.47). CONCLUSION Among military active duty and beneficiaries with HIV, modifiable factors associated with HRQOL measures included advanced HIV disease, and mental or medical comorbidity. Addressing these factors may improve quality of life of HIV-infected individuals in the NHS cohort.
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Affiliation(s)
- Leonard Emuren
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
- Public Health Program, South University, Virginia Beach, VA, United States of America
| | - Seth Welles
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Alison A. Evans
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Marcia Polansky
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Jason F. Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, United States of America
| | - Grace Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
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Tomita A, Garrett N, Werner L, Burns JK, Ngcobo N, Zuma N, Mlisana K, van Loggerenberg F, Abdool Karim SS. Impact of antiretroviral therapy on health-related quality of life among South African women in the CAPRISA 002 acute infection study. AIDS Behav 2014; 18:1801-7. [PMID: 24849623 DOI: 10.1007/s10461-014-0800-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Concerns are often raised regarding potentially adverse effects of antiretroviral therapy (ART) on health-related quality of life (HRQoL), but there is limited longitudinal data to prove this. Building on our prior investigation, we examined the impact of ART on HRQoL among HIV-infected South African women with extensive follow-up in the CAPRISA 002 Acute Infection Cohort Study. Overall HRQoL and five sub-domains [physical well-being (PWB), emotional well-being (EWB), functional and global well-being (FGWB), social well-being (SWB) and cognitive functioning (CF)] were assessed using the Functional Assessment of HIV Infection (FAHI) instrument. Our analyses comparing FAHI scores between pre-ART (established infection) and ART phases using paired Wilcoxon signed-rank tests and adjusted mixed-effects regression models revealed improvements on ART in overall HRQoL, and in PWB, EWB, and SWB, but not in FGWB and CF. No long-term adverse impact of ART on HRQoL was detected, providing additional non-biomedical support to early treatment strategies.
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Affiliation(s)
- Andrew Tomita
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa,
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Mûnene E, Ekman B. Does duration on antiretroviral therapy determine health-related quality of life in people living with HIV? A cross-sectional study in a regional referral hospital in Kenya. Glob Health Action 2014; 7:23554. [PMID: 24713353 PMCID: PMC3980475 DOI: 10.3402/gha.v7.23554] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/08/2014] [Accepted: 03/11/2014] [Indexed: 11/14/2022] Open
Abstract
Objective To measure the extent to which health-related quality of life (HRQoL) in people living with HIV is associated with duration of antiretroviral therapy (ART) after controlling for sociodemographic, clinical, and other therapy-related factors. Design Cross-sectional analysis. Methods A gender-stratified random sample of 421 participants aged 18–64 years was selected from the patients on ART at a health facility in Kenya. Three hundred and ninety two patients participated in the study, representing a 93% response rate. Data on general physical and mental health functioning status were collected using the SF-36 health survey questionnaire. Hierarchical logistic regression analysis was used to predict the SF-36 summary scores. Results In regression analyses, the duration of ART was negatively associated with HRQoL (odds ratio (OR): 0.6, 95% confidence interval (CI): 0.45–0.92) after controlling for sociodemographic, clinical, and other therapy-related factors. Patients with chronic diseases or clinical symptoms of acute illness had significantly worse HRQoL (OR: 0.5, 95% CI: 0.30–0.79 and OR: 0.3, 95% CI: 0.16–0.59, respectively). Therapy interruptions, adverse drug reactions, and World Health Organization stage at initiation of therapy were not associated with HRQoL. Conclusion Patients on ART for a relatively longer duration reported poorer HRQoL at the study facility independent of the effect of other therapy-related, clinical, and sociodemographic factors. Program managers and clinicians in the Kenyan health system may need to refocus attention on this subgroup to avert ‘loss to treatment’ that may have negative repercussions on the substantial gains made against the HIV scourge.
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Affiliation(s)
- Edwin Mûnene
- Nyeri Provincial General Hospital, Nyeri, Kenya;
| | - Björn Ekman
- Social Medicine and Global Health, Lund University, Malmö, Sweden
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Jin Y, Liu Z, Wang X, Liu H, Ding G, Su Y, Zhu L, Wang N. A systematic review of cohort studies of the quality of life in HIV/AIDS patients after antiretroviral therapy. Int J STD AIDS 2014; 25:771-7. [PMID: 24598977 DOI: 10.1177/0956462414525769] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this paper was to review cohort studies that analyze changes in the quality of life of people living with HIV/AIDS. We searched the PubMed and EmBase databases from inception to December 2012 for primary cohort studies of the quality of life of people living with HIV/AIDS after combination antiretroviral therapy (cART). Two independent reviewers screened and selected published studies of quality of life that had been followed up for more than 12 weeks after the beginning of cART. Data from the papers were analyzed to identify common characteristics of the effects of cART on the quality of life of HIV/AIDS patients. Eight cohort studies were found: only four were assessed as high quality and four were assessed as moderate quality. None of the studies described patient selection. Six studies followed the patients for one year or more, and the other studies for less than 6 months. Seven studies reported quality of life had been improved after initiation of cART, and one study reported no change. Previous research suggested that cART improved the quality of life of AIDS patients for a limited time, so further research for longer periods is needed to confirm this outcome.
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Affiliation(s)
- Yantao Jin
- Department of AIDS Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhibin Liu
- Department of AIDS Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Xin Wang
- School of International Education, Zhengzhou Railway Vocational & Technical College, Zhengzhou, China
| | - Huixin Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guowei Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yingying Su
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Zhu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Antiretroviral treatment and quality of life in Africans living with HIV: 12-month follow-up in Burkina Faso. J Int AIDS Soc 2013; 16:18867. [PMID: 24369739 PMCID: PMC3871830 DOI: 10.7448/ias.16.1.18867] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/31/2013] [Accepted: 11/27/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction The scale-up of highly active antiretroviral therapy (HAART) has led to a significant improvement in survival of the HIV-positive patient but its effects on health-related quality of life (HRQOL) are less known and context-dependent. Our aim was to assess the temporal changes and factors associated with HRQOL among HIV-positive adults initiating HAART in Burkina Faso. Methods HIV-positive people initiating HAART were prospectively included and followed over a one-year period in three HIV clinics of Ouagadougou. HRQOL was assessed at baseline and at each follow-up visit using physical (PHS) and mental (MHS) summary scores derived from the Medical Outcome Study 36-Item short-form health survey (MOS SF-36) questionnaire. Toxicity related to HAART modification and self-reported symptoms were recorded during follow-up visits. Determinants associated with baseline and changes in both scores over a one-year period were assessed using a mixed linear model. Results A total of 344 patients were included. Their median age at baseline was 37 years [interquartile range (IQR) 30–44] and their median CD4 count was 181 cells/mm3 (IQR 97–269). The mean [standard deviation (SD)] PHS score increased from 45.4 (11.1) at baseline to 60.0 (3.1) at 12 months (p<10−4) and the mean (SD) MHS score from 42.2 (8.7) to 43.9 (3.4) (p<10−2). After one year of treatment, patients that experienced on average two symptoms during follow-up presented with significantly lower PHS (63.9) and MHS (43.8) scores compared to patients that presented no symptoms with PHS and MHS of 68.2 (p<10−4) and 45.3 (p<10−3), respectively. Discussion The use of HAART was associated with a significant increase in both physical and mental aspects of the HRQOL over a 12-month period in this urban African population. Perceived symptoms experienced during follow-up visits were associated with a significant impairment in HRQOL. The appropriate and timely management of reported symptoms during the follow-up of HAART-treated patients is a key component to restore HRQOL.
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Singh H, Kaur K, Dulhani N, Bansal A, Kumar BN, Chouhan VKS. Assessment of quality of life in a cohort of newly diagnosed patients on HAART regimen, in resource restricted tribal region of chhattisgarh, India: a prospective study. J Glob Infect Dis 2013; 5:104-9. [PMID: 24049364 PMCID: PMC3766331 DOI: 10.4103/0974-777x.116870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Highly active antiretroviral therapy regimens have resulted in the systemic/clinical healing for human immune deficiency virus-infected patients but the consequence of antiretroviral therapy on the whole quality of life has become a major concern. The current study correlates the relationship of quality of life with successful highly active antiretroviral therapy. AIM To determine the health-related quality of life in human immune deficiency virus-infected patients on highly active anti-retroviral therapy regimen in tribal region of Chhattisgarh. DESIGN An open label prospective study. MATERIALS AND METHODS Health-related quality of life was assessed using a standardized questionnaire, the Medical Outcomes Survey Short Form 36. Physical health summary scores and mental health summary scores were compared of pre-Highly Active Anti-Retroviral Therapy (at baseline) and post 12 months of therapy. RESULTS The increase in CD4 cell counts was extremely significant (P < 0.0001). The Physical Composite Summary (P value = 0.0003) improved significantly, whereas the Mental Composite Summary (with a baseline value of 40.7), post 12 months, was calculated as 42.8 (P value = 0.2371) and was statistically not significant. CONCLUSION Efficacy measurement is the key ingredient of highly active anti-retroviral therapy, which must also include assessment of health-related quality of life to maximize the holistic approach towards disease.
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Affiliation(s)
- Harminder Singh
- Department of Pharmacology, GGS Medical College, Faridkot, Punjab, India
| | - Kamalpreet Kaur
- Department of Pharmacology, GGS Medical College, Faridkot, Punjab, India
| | - Navin Dulhani
- Department of Medicine, Government Medical College, Jagdalpur, Chhattisgarh, India
| | - Akash Bansal
- Department of Biochemestry, Government Medical College, Jagdalpur, Chhattisgarh, India
| | - Bithika N. Kumar
- Department of Pharmacology, Government Medical College, Jagdalpur, Chhattisgarh, India
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Gakhar H, Kamali A, Holodniy M. Health-related quality of life assessment after antiretroviral therapy: a review of the literature. Drugs 2013; 73:651-72. [PMID: 23591907 PMCID: PMC4448913 DOI: 10.1007/s40265-013-0040-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antiretroviral (ARV) treatment for HIV infection has resulted in significant improvement in immunologic and virologic parameters, as well as a reduction in AIDS-defining illnesses and death. Over 25 medications are approved for use, usually in combination regimens of three or four ARVs. Several ARVs are now available as combinatorial products, which have been associated with better adherence. However, while ARV therapy has prolonged life, ARVs also pose a challenge for quality of life as they can cause significant side effects in addition to the potential for drug toxicity and interaction. Given the many complications, side effects and symptoms of HIV/AIDS in addition to associated medical and psychiatric co-morbidities, the need to understand and assess how these interactions may affect health-related quality of life (HRQOL) has grown. Numerous instruments (some validated, others not) are available and have been applied to understanding how ARV treatment affects HRQOL in those with HIV infection, both in clinical trials and clinical practice. In general, ARV treatment improves HRQOL, but this is dependent on the population being studied, the HRQOL instrument being used and the timeframe during which HRQOL has been studied. This article provides a review of the literature on quality of-life assessment as it relates to ARV treatment in developed countries and briefly reviews the HRQOL instruments used, how they have been applied to ARV utilization, and where future research should be applied in HRQOL assessment and HIV infection.
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Affiliation(s)
- Harleen Gakhar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Amanda Kamali
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark Holodniy
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA. VA Palo Alto Health Care System, 3801 Miranda Ave. (132), Palo Alto, CA 94304, USA
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Deribew A, Deribe K, Reda AA, Tesfaye M, Hailmichael Y, Maja T, Colebunders R. Change in quality of life: a follow up study among patients with HIV infection with and without TB in Ethiopia. BMC Public Health 2013; 13:408. [PMID: 23627925 PMCID: PMC3649920 DOI: 10.1186/1471-2458-13-408] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/25/2013] [Indexed: 11/30/2022] Open
Abstract
Background There is a dearth of literature on the impact of TB/HIV co-infection on quality of life (QoL). We conducted a study to assess the change in QoL over a 6-months period and its predictors among HIV-infected patients with and without TB in Ethiopia. Methods 465 HIV-infected patients without TB and 124 TB/HIV co-infected patients were enrolled in a prospective study in February, 2009. 455 (98%) HIV-infected and 97 (78%) TB/HIV co-infected patients were followed for 6 months. Data on QoL at baseline and 6th month were collected by trained nurses through face to face interviews using the short Amharic version of the World Health Organization Quality of Life Instrument for HIV clients (WHOQOL HIV-Brief). Common Mental Disorder (CMD) was assessed using a validated version of the Kessler-10 scale. Multivariate analysis was conducted using generalized estimating equations (GEE) using STATA to assess change in QoL and its predictors. Results There was a statistically significant improvement of the physical, psychological, social, environmental and spiritual QoL at the 6th months follow up compared to the baseline for both groups of patients (P < 0.0001). The change in QoL in all dimension were more marked for TB/HIV co-infected patients compared to HIV-infected patients without TB. A severe form of CMD was strongly associated with poorer physical QoL among TB/HIV co-infected individuals (β = −2.84; P = 0.000) and HIV clients without TB (β = −2.34; P = 0.000). Conclusion This study reveals that ART and anti-TB treatment significantly improve the QoL particularly among TB/HIV co-infected patients. We recommend that the ministry of health in collaboration with partners shall integrate mental health services into the TB/HIV programs and train health care providers to timely identify and treat CMD to improve QoL.
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Affiliation(s)
- Amare Deribew
- Department of Epidemiology, Jimma University, Jimma, Ethiopia.
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Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda. J Acquir Immune Defic Syndr 2012; 61:179-86. [PMID: 22692093 DOI: 10.1097/qai.0b013e318261f064] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status. DESIGN The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda. METHODS Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics. RESULTS Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41% were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b = -1.6; 95% confidence interval: -2.7 to -0.45) and ending with the final quarter (b = -6.4; 95% confidence interval: -10.3 to -2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security. CONCLUSIONS Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.
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Oguntibeju OO. Quality of life of people living with HIV and AIDS and antiretroviral therapy. HIV AIDS (Auckl) 2012; 4:117-24. [PMID: 22893751 PMCID: PMC3418767 DOI: 10.2147/hiv.s32321] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The development of antiretroviral drugs has significantly changed the perception of HIV/AIDS from a very fatal to a chronic and potentially manageable disease, and the availability and administration of antiretroviral therapy (ART) has significantly reduced mortality and morbidity associated with HIV and AIDS. There is a relationship between ART and quality of life of people living with HIV and AIDS, and several studies have reported a strong positive association between ART and improved quality of life in different domains among people living with HIV and AIDS in both developed and developing countries. However, a few studies have reported on the negative effects of ART, which directly or indirectly relate to the quality of life and longevity of HIV-infected persons. In this review, the effects and benefits of ART on people living with HIV and AIDS based on studies done in developed and developing countries is examined.
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Affiliation(s)
- Oluwafemi O Oguntibeju
- Oxidative Stress Research Centre, Cape Peninsula University of Technology, Bellville, South Africa
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Edelman EJ, Gordon K, Rodriguez-Barradas MC, Justice, for the VACS Project Team AC. Patient-reported symptoms on the antiretroviral regimen efavirenz/emtricitabine/tenofovir. AIDS Patient Care STDS 2012; 26:312-9. [PMID: 22612469 DOI: 10.1089/apc.2012.0044] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Most patients (80-90%) newly diagnosed with HIV are started on the antiretroviral regimen efavirenz, emtricitabine, and tenofovir (EFV/FTC/TDF). Existing studies of patient tolerability, however, are limited. We compared symptom experiences of patients on EFV/FTC/TDF, and the subsequent impact on health-related quality of life, with those of patients on other combination antiretroviral therapy (cART). We conducted a cross-sectional analysis of the Veterans Aging Cohort Study from February 2008 to August 2009 to compare the symptom experiences of patients on EFV/FTC/TDF vs. other cART, unadjusted and then adjusted for treatment characteristics, and comorbid disease severity. We then assessed the association between EFV/FTC/TDF use and health-related quality of life. Among the 1,759 patients in our analytic sample, EFV/FTC/TDF use was associated with fewer symptoms than was other cART. The use of EFV/FTC/TDF was independently associated with health-related quality of life, and this association was at least partially explained by symptom burden.
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Affiliation(s)
- E. Jennifer Edelman
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kirsha Gordon
- Section of General Internal Medicine, Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Maria C. Rodriguez-Barradas
- Section of Infectious Diseases, Department of Medicine, Michael E. De Bakey VAMC and Baylor College of Medicine, Houston, Texas
| | - Amy C. Justice, for the VACS Project Team
- Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
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Grijsen ML, Koster GT, van Vonderen MGA, van Kasteren M, Kootstra GJ, Steingrover R, de Wolf F, Prins JM, Nieuwkerk PT. Temporary antiretroviral treatment during primary HIV-1 infection has a positive impact on health-related quality of life: data from the Primo-SHM cohort study. HIV Med 2012; 13:630-5. [DOI: 10.1111/j.1468-1293.2012.01020.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2012] [Indexed: 12/01/2022]
Affiliation(s)
- ML Grijsen
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity, Academic Medical Center; University of Amsterdam; Amsterdam; the Netherlands
| | - GT Koster
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity, Academic Medical Center; University of Amsterdam; Amsterdam; the Netherlands
| | - MGA van Vonderen
- Department of Internal Medicine; Medical Center Leeuwarden; Leeuwarden; the Netherlands
| | - M van Kasteren
- Department of Internal Medicine; St. Elisabeth Hospital; Tilburg; the Netherlands
| | - GJ Kootstra
- Department of Internal Medicine; Medisch Spectrum Twente Hospital; Enschede; the Netherlands
| | | | - F de Wolf
- HIV Monitoring Foundation; Amsterdam; the Netherlands
| | - JM Prins
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity, Academic Medical Center; University of Amsterdam; Amsterdam; the Netherlands
| | - PT Nieuwkerk
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam; the Netherlands
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Safren SA, Hendriksen ES, Smeaton L, Celentano DD, Hosseinipour MC, Barnett R, Guanira J, Flanigan T, Kumarasamy N, Klingman K, Campbell T. Quality of life among individuals with HIV starting antiretroviral therapy in diverse resource-limited areas of the world. AIDS Behav 2012; 16:266-77. [PMID: 21499794 DOI: 10.1007/s10461-011-9947-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As Antiretroviral Therapy (ART) is scaled up in low- and middle-income countries, it is important to understand Quality of Life (QOL) correlates including disease severity and person characteristics and to determine the extent of between-country differences among those with HIV. QOL and medical data were collected from 1,563 of the 1,571 participants at entry into a randomized clinical trial of ART conducted in the U.S. (n = 203) and 8 resource-limited countries (n = 1,360) in the Caribbean, South America, Asia, and Africa. Participants were interviewed prior to initiation of ART using a modified version of the ACTG SF-21, a health-related QOL measure including 8 subscales: general health perception, physical functioning, role functioning, social functioning, cognitive functioning, pain, mental health, and energy/fatigue. Other measures included demographics, CD4+ lymphocyte count, plasma HIV-1 RNA viral load. Higher quality of life in each of the 8 QOL subscales was associated with higher CD4+ lymphocyte category. General health perception, physical functioning, role functioning, and energy/fatigue varied by plasma HIV-1 RNA viral load categories. Each QOL subscale included significant variation by country. Only the social functioning subscale varied by sex, with men having greater impairments than women, and only the physical functioning subscale varied by age category. This was the first large-scale international ART trial to conduct a standardized assessment of QOL in diverse international settings, thus demonstrating that implementation of the behavioral assessment was feasible. QOL indicators at study entry varied with disease severity, demographics, and country. The relationship of these measures to treatment outcomes can and should be examined in clinical trials of ART in resource-limited settings using similar methodologies.
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Protopopescu C, Raffi F, Brunet-François C, Salmon D, Verdon R, Reboud P, Carrieri MP, Leport C, Spire B, Michel L. Incidence, medical and socio-behavioural predictors of psychiatric events in an 11-year follow-up of HIV-infected patients on antiretroviral therapy. Antivir Ther 2012; 17:1079-83. [DOI: 10.3851/imp2102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2011] [Indexed: 10/27/2022]
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Armon C, Lichtenstein K. The associations among coping, nadir CD4+ T-cell count, and non-HIV-related variables with health-related quality of life among an ambulatory HIV-positive patient population. Qual Life Res 2011; 21:993-1003. [PMID: 21938643 DOI: 10.1007/s11136-011-0017-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated HRQoL among HIV-positive outpatients from October, 2006-December, 2007, incorporating medical chart review, and a survey of coping styles. METHODS Consented HIV-positive patients receiving medical care at University of Colorado Denver, with HAART as first antiretroviral regimen, completed the MOS-HIV and Brief COPE survey instruments. Linear regression identified a priori factors hypothesized to be associated with the MOS-HIV composite mental and physical health scores (MHS, PHS). Brief COPE survey maladaptive and adaptive coping components were added to the models and retained if significant. RESULTS Among the 157 patient cohort, parsimonious multivariable linear regression models (P < 0.05) indicated higher nadir CD4+ T-cell counts and adaptive coping were associated with a higher MHS; public/no insurance, mental illness, current number of non-HIV medications, and maladaptive coping were inversely associated with MHS. Nadir CD4+ T-cell count and efavirenz use were associated with a higher PHS; mental illness, current number of non-HIV mediations, and maladaptive coping were inversely associated with PHS. CONCLUSIONS Factors independently associated with lower MHS and lower PHS include lower nadir CD4+ T-cell counts, and use of maladaptive coping. Efforts to reduce use of maladaptive coping strategies and earlier identification and treatment of HIV may improve HRQoL in HIV-positive patients.
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Affiliation(s)
- Carl Armon
- Children's Hospital Colorado, Aurora, CO, USA.
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Abstract
Prior research has consistently demonstrated that providers often under recognize symptoms. However, this research was limited by the different ways in which patients and providers were asked about the symptoms patients experience. We sought to (1) describe the prevalence of patient-reported symptoms in the post-cART era; (2) identify those patient-reported symptoms which are most strongly associated with health-related quality of life (HRQoL), hospitalization and mortality; and (3) determine whether primary providers recognize symptoms associated with HRQoL, hospitalization and mortality. We conducted a secondary analysis using baseline survey data from the Veterans Aging Cohort Study and determined which patient-reported symptoms correlated with clinical outcomes using regression analyses. Kappa scores were then calculated. HIV-infected patients suffer from a high burden of symptoms in the post-cART era. Nine out of 20 symptoms correlated with clinical outcomes. Providers universally under recognized symptoms and demonstrated poor agreement beyond chance when patient-report was used as the gold standard.
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Affiliation(s)
- E J Edelman
- Robert Wood Johnson Clinical Scholars Program, New Haven, CT, USA.
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Mohammadpour A, Yekta ZP, Nikbakht Nasrabadi AR. HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study. Nurs Health Sci 2010; 12:464-9. [PMID: 21210925 DOI: 10.1111/j.1442-2018.2010.00560.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy.
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Affiliation(s)
- Ali Mohammadpour
- Department of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran.
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Gouvernet B, Combaluzier S, Viaux JL. [Defense mechanisms and perceived adverse effects in a population of 70 HIV infected adults]. Med Mal Infect 2010; 41:80-6. [PMID: 21051163 DOI: 10.1016/j.medmal.2010.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 05/27/2010] [Accepted: 09/30/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We assessed the relations between defense mechanisms and perceived adverse effects of ART in a population of 70 HIV positive patients. DESIGN The Bond Defense Style questionnaire was used to evaluate defense mechanisms. We used Justice's questionnaire to assess adverse effects and their psychological impact. We carried out multiple regression and mediation analyses to define the relations between the number of adverse effects, defensive styles, and the impact of adverse effects. RESULTS The global model accounts for nearly 40 % of the score variance. Mature and immature defense styles bring significant contribution to understanding the impact of adverse effects, even when their number is controlled. CONCLUSION Working on defense mechanisms should lower the psychological impact of adverse effects, therefore, improving the patient's quality of life and compliance.
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Affiliation(s)
- B Gouvernet
- UFR des Sciences de l'Homme et de la Société, Laboratoire PSY-NCA, Université de Rouen, rue Lavoisier, 76821 Mont-Saint-Aignan cedex, France.
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Fox MP, McCoy K, Larson BA, Rosen S, Bii M, Sigei C, Shaffer D, Sawe F, Wasunna M, Simon JL. Improvements in physical wellbeing over the first two years on antiretroviral therapy in western Kenya. AIDS Care 2010; 22:137-45. [PMID: 20390492 DOI: 10.1080/09540120903038366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Improvements in physical wellbeing during the first six months on antiretroviral therapy (ART) are well known, but little is known regarding long-term follow-up. We conducted a prospective cohort study among 222 HIV-positive adult tea plantation workers in western Kenya to assess wellbeing over their first two years on ART. Study subjects completed a standardized questionnaire during repeat ART clinic visits. A 30-day recall period was used to elicit the number of days when subjects experienced poor health and the number of days that pain made it difficult to complete usual activities at home and work. A seven-day recall period was used to assess the severity of bodily pain, nausea, fatigue, and rash. Prevalence of most symptoms declined over time. A median of seven days poor health during the first month on ART declined to three days in the 24th month (p=0.043). For pain making usual activities difficult, a median of seven days during the first month on ART fell to zero by 12 months (p< or =0.0001) but increased to three days by two years. Any bodily pain (range 59-83%) and fatigue (range 51-84%) over the past seven days were common through two years. However, pain and fatigue often over the past seven days declined over two years (from 24-10% (p=0.067) and 41-15% (p=0.002)). Skin rash was rare at all times, though higher at two years (8.6%) than any other time. Initial improvements in physical wellbeing were sustained over two years, however, increased pain and skin rash at year two may indicate problems as treatment programs mature. These improvements in physical wellbeing will be important in sustaining the long-term success of HIV treatment programs.
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Affiliation(s)
- Matthew P Fox
- Department of International Health, Center for Global Health and Development, School of Public Health, Boston University, Boston, MA, USA.
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HRQoL in HIV-infected children using PedsQL™ 4.0 and comparison with uninfected children. Qual Life Res 2010; 19:803-12. [DOI: 10.1007/s11136-010-9643-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2010] [Indexed: 10/19/2022]
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Abasiubong F, Ekott JU, Bassey EA, Etukumana EA, Edyang-Ekpa M. Quality of life in people living with HIV/AIDS in Niger Delta Region, Nigeria. J Ment Health 2010; 19:211-8. [DOI: 10.3109/09638230903469210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Seeley J, Russell S. Social rebirth and social transformation? Rebuilding social lives after ART in rural Uganda. AIDS Care 2010; 22 Suppl 1:44-50. [DOI: 10.1080/09540121003605054] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Janet Seeley
- a School of International Development , University of East Anglia , Norwich , NR4 7TJ , UK
- b MRC/UVRI Uganda Research Unit on AIDS , P.O. Box 49, Entebbe , Uganda
| | - Steve Russell
- a School of International Development , University of East Anglia , Norwich , NR4 7TJ , UK
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Duval X, Mentré F, Rey E, Auleley S, Peytavin G, Biour M, Métro A, Goujard C, Taburet AM, Lascoux C, Panhard X, Tréluyer JM, Salmon-Céron D. Benefit of therapeutic drug monitoring of protease inhibitors in HIV-infected patients depends on PI used in HAART regimen--ANRS 111 trial. Fundam Clin Pharmacol 2009; 23:491-500. [PMID: 19709326 PMCID: PMC2933222 DOI: 10.1111/j.1472-8206.2009.00693.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
As a result of high inter-patient variability, and efficacy-concentration and toxicity-concentration relationships, optimization of HIV-protease inhibitor (PI) doses based on plasma concentrations could be beneficial. During a 48-week open prospective non-randomized interventional study of 115 protease inhibitor-naïve patients initiating an indinavir/ritonavir- or lopinavir/ritonavir-, or nelfinavir-containing therapy, protease inhibitor dose was modified when plasma trough concentrations (C(trough)) at weeks 2, 8, 16 and 24 were outside predefined optimal concentration ranges. Failure of the strategy was defined as the proportions of patients with HIV-RNA above 200 copies/mL from weeks 24 to 48 and/or experiencing grades 2, 3 or 4 PI-related adverse events during the study; proportion of patients with last C(trough) measurement outside the concentration range was determined at each visit. Virological failure and/or occurrence of adverse event were observed in 37/94 assessable patients (39%; 95% CI: 29.4-50.0). In the on-treatment analysis, failure of the strategy was noted in 16% of indinavir/r- or lopinavir/r-treated patients (8/51; 95% CI: 7.0-28.6; virological failure: 2; adverse event: 6) but in 44% of nelfinavir-treated patients (11/25; 95% CI: 24.4-65.1; virological failure: 10; adverse event: 1); C(trough) concentrations outside the range were less frequent at the last measurement than at W2 (41% vs. 66%; P < 0.05), with proportions of 35% for indinavir/r- or lopinavir/r-treated patients, but 57% for nelfinavir-treated patients. The proposed strategy of therapeutic drug monitoring may be beneficial to indinavir/r- and lopinavir/r-treated patients, but failed to move concentrations into the predefined range and to produce the expected virological success for nelfinavir-treated patients.
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Wang H, Zhou J, He G, Luo Y, Li X, Yang A, Fennie K, Williams AB. Consistent ART adherence is associated with improved quality of Life, CD4 counts, and reduced hospital costs in central China. AIDS Res Hum Retroviruses 2009; 25:757-63. [PMID: 19618996 DOI: 10.1089/aid.2008.0173] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to assess levels of ART adherence and to examine the relationship between adherence and treatment outcomes. A longitudinal study in Hunan and Hubei provinces used the CPCRA Antiretroviral Medication Self-Report and a 7-day Visual Analogue Scale to assess levels of adherence, while quality of life was evaluated using SF-36. CD4 cell count and the number, duration, and cost of hospitalizations were collected from participant medical records. Measurements were obtained at baseline, month 3, and month 6. A total of 113 participants enrolled and 98 completed the study. The mean level of adherence was 91%, 89%, and 88% at baseline and at 3 and 6 months, respectively. Of participants, 54/98 (58%) reported taking all doses at all three interviews and were classified as consistent adherers (CA). CAs had better physical function (p = 0.001), general health (p = 0.009), vitality (p = 0.016), social functioning (p = 0.001), and mental health (p = 0.023), and presented a higher CD4 cell count (p = 0.028). CAs also had fewer hospital admissions and readmissions (p = 0.005), shorter hospital stays (p = 0.005), and lower hospital expenses (p = 0.006). Consistent adherence is associated with better outcomes including improved quality of life, higher CD4 counts, and lower health care costs.
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Affiliation(s)
- Honghong Wang
- School of Nursing, Central South University, Changsha 410013, Hunan, China
| | - Jun Zhou
- School of Nursing, Central South University, Changsha 410013, Hunan, China
| | - Gouping He
- School of Nursing, Central South University, Changsha 410013, Hunan, China
| | - Yang Luo
- School of Nursing, Central South University, Changsha 410013, Hunan, China
| | - Xianhong Li
- School of Nursing, Central South University, Changsha 410013, Hunan, China
| | - Aiyun Yang
- School of Nursing, Central South University, Changsha 410013, Hunan, China
| | | | - Ann B. Williams
- Yale University, School of Nursing, New Haven, Connecticut 06520
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Protopopescu C, Raffi F, Roux P, Reynes J, Dellamonica P, Spire B, Leport C, Carrieri MP. Factors associated with non-adherence to long-term highly active antiretroviral therapy: a 10 year follow-up analysis with correction for the bias induced by missing data. J Antimicrob Chemother 2009; 64:599-606. [DOI: 10.1093/jac/dkp232] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Bajunirwe F, Tisch DJ, King CH, Arts EJ, Debanne SM, Sethi AK. Quality of life and social support among patients receiving antiretroviral therapy in Western Uganda. AIDS Care 2009; 21:271-9. [PMID: 19280404 DOI: 10.1080/09540120802241863] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Quality of life (QOL) among patients with HIV/AIDS has been shown to improve once treatment with antiretroviral therapy (ART) has been initiated. We conducted a cross-sectional study in Western Uganda to examine the factors associated with QOL among patients who had received ART for the duration of at least six months. We interviewed 330 patients attending the HIV/AIDS clinic at two government-supported hospitals in Western Uganda. We measured QOL using a culturally adapted version of the Medical Outcomes Study (MOS-HIV) tool and calculated the physical health summary (PHS) and mental health summary (MHS) scores. In addition, data were collected on sociodemographic factors, three-day self-reported adherence, social support, sexual behavior, CD4 count and viral load. Informational social support was significantly positively correlated with PHS (p=0.001) and MHS (p=0.002). Affectionate support was also significantly positively correlated to PHS (p=0.05) and MHS (p=0.03) but tangible support was not (PHS p value=0.85 and MHS p value=0.31). In the univariate analysis, older age, rural dwelling, alcohol use, CD4 count less than 200, and ART duration of less than one year were significantly associated with lower PHS scores. Lower PHS scores were also associated with sexual inactivity. In multivariate analysis, higher scores on informational social support and CD4> or =200 were associated with higher PHS score and past or recent alcohol consumption was associated with lower scores on MHS. Optimizing ART to restore CD4 count and provision of informational and affectionate social support but not tangible support, to HIV/AIDS patients may improve their QOL.
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Affiliation(s)
- Francis Bajunirwe
- Department of Community Health, Mbarara University, Mbarara, Uganda.
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Pitt J, Myer L, Wood R. Quality of life and the impact of drug toxicities in a South African community-based antiretroviral programme. J Int AIDS Soc 2009; 12:5. [PMID: 19393051 PMCID: PMC2683808 DOI: 10.1186/1758-2652-12-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 04/24/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The impact of highly active antiretroviral therapy (HAART) on health-related quality of life has been widely researched in the developed world, but there are few data from sub-Saharan Africa, where the vast majority of HIV-infected individuals live. This study examined health-related quality of life among HIV-positive individuals initiating HAART in Cape Town, South Africa, and explored the impact of HAART-related drug toxicities on quality of life. METHODS Health-related quality of life was assessed using a standardised questionnaire, the Medical Outcomes Survey Short Form 36. Physical health summary scores and mental health summary scores were compared pre-HAART and at regular intervals during the first 48 weeks of HAART. The relationships between socio-demographic, baseline and on-treatment variables and decline in health-related quality of life, as well as the impact of drug toxicities on quality of life, were assessed in unadjusted bivariate and adjusted multivariate analyses. RESULTS Two hundred and ninety-five patients were enrolled into the study. There was a significant increase in health-related quality of life during the first 48 weeks on HAART. The median physical health summary score increased from 45 to 53 units (p < 0.001) and median mental health summary score increased from 45 to 50 units (p < 0.001).The bulk of this increase occurred during the first 16 weeks. Overall, 23% of participants experienced a decline in their physical health summary score, while 34% showed a decline in the mental health summary score. Average drops in median physical and mental health summary scores were 8.4 units (SD 9.31) and 9.9 (SD 11.4) units respectively. Participants with drug toxicity had lower physical health summary scores than participants without drug toxicity at all time points. However, only three participants with toxicity (27%) reported an actual decline in health-related quality of life by week 48. Drug toxicities had little impact on mental health summary scores. CONCLUSION These results confirm the health-related quality of life benefits of HAART. While the majority of patients experienced a significant improvement in health-related quality of life on HAART, up to a third of patients reported declines in this quality of life. This was largely related to better baseline clinical state. HAART-related drug toxicities did not have a significant impact on health-related quality of life during the first year of HAART, which supports the ongoing use of the current national first-line regimen.
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Affiliation(s)
- Jennifer Pitt
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Cape Town, South Africa
| | - Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robin Wood
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Cape Town, South Africa
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Wouters E, Heunis C, van Rensburg D, Meulemans H. Physical and emotional health outcomes after 12 months of public-sector antiretroviral treatment in the Free State Province of South Africa: a longitudinal study using structural equation modelling. BMC Public Health 2009; 9:103. [PMID: 19368714 PMCID: PMC2678117 DOI: 10.1186/1471-2458-9-103] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 04/15/2009] [Indexed: 11/10/2022] Open
Abstract
Background African and Asian cohort studies have demonstrated the clinical efficacy of antiretroviral treatment (ART) in resource-limited settings. However, reports of the long-term changes in the physical and emotional quality of life (QoL) of patients on ART in these settings are still scarce. In this study, we assessed the physical and emotional QoL after six and 12 months of ART of a sample of 268 patients enrolled in South Africa's public-sector ART programme. The study also tested the impact of the adverse effects of medication on patients' physical and emotional QoL. Methods A stratified random sample of 268 patients undergoing ART was interviewed at baseline (< 6 months ART) and follow-up (< 12 months ART). A model of the relationships between the duration of ART, the adverse effects of medication, and physical and emotional QoL (measured using EUROQOL-5D) was tested using structural equation modelling. Results The improved physical and emotional QoL shown at baseline was sustained over the 12-month study period, because treatment duration was not significantly associated with changes in the patients' QoL. Physical QoL significantly and positively influenced the patients' emotional QoL (subjective well-being [SWB]) (β = 0.33, P < 0.01). Longitudinal data showed that patients reported significantly fewer adverse effects at follow-up than at baseline (β = -0.38, P < 0.001) and that these adverse effects negatively influenced physical (β = -0.27, P < 0.01) and emotional QoL (β = -0.15, P < 0.05). Conclusion This study provides evidence that the South African public-sector ART programme is effective in delivering sustained improvement in patient well-being. However, the results should encourage clinicians and lay health workers to be vigilant regarding the adverse effects of treatment, because they can seriously affect physical and emotional QoL.
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Affiliation(s)
- Edwin Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Sint-Jacob Street 2, 2000 Antwerp, Belgium.
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Applebaum AJ, Richardson MA, Brady SM, Brief DJ, Keane TM. Gender and other psychosocial factors as predictors of adherence to highly active antiretroviral therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav 2009; 13:60-5. [PMID: 18690532 DOI: 10.1007/s10461-008-9441-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 07/18/2008] [Indexed: 10/21/2022]
Abstract
This study assessed adherence to HAART among 67 HIV-infected adults, and the degree to which gender and psychological factors-including depression, drug and alcohol use, quality of life, and medication side effects-influenced adherence. Although overall adherence was greater than rates reported in similar studies, no significant difference in adherence was observed between men and women in the present sample. Medication side effects were a significant predictor of non-adherence in the sample at large and among women in particular, while alcohol dependence was a significant predictor of non-adherence only in women. Possible explanations are explored.
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Campos LN, César CC, Guimarães MDC. Quality of life among HIV-infected patients in Brazil after initiation of treatment. Clinics (Sao Paulo) 2009; 64:867-75. [PMID: 19759880 PMCID: PMC2745298 DOI: 10.1590/s1807-59322009000900007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 06/29/2009] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Despite improvement in clinical treatment for HIV-infected patients, the impact of antiretroviral therapy on the overall quality of life has become a major concern. OBJECTIVE To identify factors associated with increased levels of self-reported quality of life among HIV-infected patients after four months of antiretroviral therapy. METHODS Patients were recruited at two public health referral centers for AIDS, Belo Horizonte, Brazil, for a prospective adherence study. Patients were interviewed before initiating treatment (baseline) and after one and four months. Quality of life was assessed using a psychometric instrument, and factors associated with good/very good quality of life four months after the initiation of antiretroviral therapy were assessed using a cross-sectional approach. Logistic regression was used for analysis. RESULTS Overall quality of life was classified as 'very good/good' by 66.4% of the participants four months after initiating treatment, while 33.6% classified it as 'neither poor nor good/poor/very poor'. Logistic regression indicated that >8 years of education, none/mild symptoms of anxiety and depression, no antiretroviral switch, lower number of adverse reactions and better quality of life at baseline were independently associated with good/very good quality of life over four months of treatment. CONCLUSIONS Our results highlight the importance of modifiable factors such as psychiatric symptoms and treatment-related variables that may contribute to a better quality of life among patients initiating treatment. Considering that poor quality of life is related to non-adherence to antiretroviral therapy, careful clinical monitoring of these factors may contribute to ensuring the long-term effectiveness of antiretroviral regimens.
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Affiliation(s)
- Lorenza Nogueira Campos
- Department of Preventive and Social Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte/MG, Brazil.
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Préau M, Villes V, Spire B. La rupture de confiance envers le médecin auprès de patients infectés par le VIH : quels déterminants psychosociaux ? ACTA ACUST UNITED AC 2009. [DOI: 10.3917/cips.082.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sansgiry SS, Ajuoga E, Ngo C, Yeh RF. Impact of Over-the-Counter Medication Misuse and Adverse Drug Events on HIV Patients' Health-Related Quality of Life. J Pharm Technol 2008. [DOI: 10.1177/875512250802400602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Over-the-counter (OTC) medication use has increased among HIV-infected patients. Inappropriate use of OTC drugs may increase the risk of potential adverse drug events (ADEs), thus decreasing health-related quality of life (HRQL). Objective: To examine the effect of OTC medication misuse and associated ADEs on HRQL of HIV-infected patients. Methods: A cross-sectional field study with HIV-infected patients from an HIV clinic in Houston, Texas, was conducted from April 1, 2005, to June 30, 2005. A validated questionnaire (including questions on OTC medications used; ADEs experienced; and HRQL, Short Form-12, version 2 scale) was administered using self-administered and personal interview techniques. Cronbach's α was estimated to evaluate internal consistency for HRQL scores and χ2 and t-test analyses were performed to evaluate the effect of OTC misuse on ADEs and on HRQL. Results: Of the 215 respondents, 80 (37.2%) misused OTC medications. Thirty-six participants (16.7%) experienced ADEs due to OTC use or misuse. ADE incidence was significantly higher in patients misusing OTCs. Significantly lower HRQL scores for the physical component summary score domains were observed in patients reporting ADEs versus those who did not. Conclusions: HIV-infected patients had lower HRQL scores when they experienced an OTC-associated ADE. Patients misusing OTC medications had a higher incidence of associated ADEs. Interventions by healthcare providers and patients aimed at reducing misuse and ADEs due to OTC medications would improve care and the quality of life for HIV-infected patients.
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Affiliation(s)
- Sujit S Sansgiry
- SUJIT S SANSGIRY PhD, Associate Professor and Director, Graduate Studies, Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, TX
| | - Elizabeth Ajuoga
- ELIZABETH AJUOGA MS, Student, Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston
| | - Caroline Ngo
- CAROLINE NGO PharmD MS, Pharmacist, Walgreens Pharmacy, Houston
| | - Rosa F Yeh
- ROSA F YEH PharmD BCPS, Assistant Professor, Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston
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Spire B, de Zoysa I, Himmich H. HIV prevention: What have we learned from community experiences in concentrated epidemics? J Int AIDS Soc 2008; 11:5. [PMID: 19014656 PMCID: PMC2584058 DOI: 10.1186/1758-2652-11-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 10/01/2008] [Indexed: 11/10/2022] Open
Abstract
Drawing on lessons learned from community experiences in concentrated epidemics, this paper explores three imperatives in the effort to reduce the sexual transmission of HIV: combat prevention fatigue, diversify HIV testing and combat stigma and discrimination. The paper argues for a non-judgmental harm reduction approach to the prevention of sexual transmission of HIV that takes into account the interpretation of risk by diverse individuals and communities in the era of antiretroviral therapy. This approach requires greater attention to increasing access to opportunities to know one's serostatus, especially among key populations at greater risk. Novel approaches to diversifying HIV testing approaches at community level are needed. Finally, the paper makes a plea for bold measures to combat stigma and discrimination, which continues to represent a formidable barrier for access to services for affected populations and may contribute to HIV-related risk behaviours. A "triple therapy" approach to address stigma and discrimination is discussed, which includes greater acceptance of people living with HIV and AIDS (PLWHA), improving relevant laws and policies, and involving prevention users- working with people rather than for people-.Note: this paper corresponds to the plenary talk of Bruno Spire at the XVIIth World AIDS Conference, August 8th, Mexico city: http://www.kaisernetwork.org/health_cast/player.cfm?id=4383.
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del Castillo LS, Ruiz-Pérez I, de Labry-Lima AO, Soto-Blanco JM, Girela-López E, Castro-Recio JM, Antón-Basanta JJ. Influence of antiretroviral treatment on quality of life in seropositive inmates. Int J STD AIDS 2008; 19:172-7. [PMID: 18397557 DOI: 10.1258/ijsa.2007.007093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study is to evaluate the influence of antiretroviral treatment on health-related quality of life (HRQOL) of three groups of HIV-positive inmates: those who are taking antiretroviral treatment, those who are not on treatment as it has not yet been indicated, and those who refuse to take treatment even though it has been recommended. A cross-sectional study was conducted on 585 HIV+ inmates in three prisons. The response variable was HRQOL. Independent variables were: sociodemographic variables, psychosocial and drug-related variables. Two multivariate linear regression models were constructed in order to determine the HRQOL, physical health score (PHS) and mental health score (MHS), for each of the three groups identified, using patients who refused treatment as the reference category. Patients who refused therapy had a lower MHS compared with patients in whom treatment was not indicated (P = 0.038). With regard to PHS, patients refusing therapy had a lower score than patients who were not indicated therapy (P = 0.005), and than patients receiving therapy (P = 0.010).
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Spire B, Marcellin F, Cohen-Codar I, Flandre P, Boue F, Dellamonica P, Raffi F, Norton M, Ngo Van P, Delfraissy JF. Effect of Lopinavir/Ritonavir Monotherapy on Quality of Life and Self-Reported Symptoms among Antiretroviral-Naive Patients: Results of the MONARK Trial. Antivir Ther 2008. [DOI: 10.1177/135965350801300405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Standard-of-care for HIV-infected patients consists of combining three antiretroviral drugs. However, other therapeutic strategies could be beneficial given long-term toxicity and quality of life (QOL) issues associated with taking multiple antiretroviral drugs for many years. In the prospective, open label, randomized, pilot monotherapy antiretroviral Kaletra® (MONARK) trial among antiretroviral-naive patients, lopinavir/ritonavir (LPV/r) monotherapy was found to be less suppressive for HIV RNA than a standard triple-drug therapy of LPV/r plus zidovudine/lamivudine (on-treatment analysis after 48 weeks). We present data from the MONARK trial concerning QOL and patient-reported symptoms. Methods Patient-reported symptoms were collected at baseline and at weeks 4, 12, 24 and 48 using a list of 22 symptoms. QOL was assessed at baseline, week 24 and week 48 using the six-domain World Health Organization QOL short form questionnaire for HIV-infected individuals including an evaluation of global health perception. Results Patients treated with the standard triple-drug therapy reported significantly more symptoms over 48 weeks of treatment than patients treated with LPV/r monotherapy (incidence rate ratio [95% confidence interval] 1.3 [1.1, 1.6] P=0.001 and 1.4 [1.2, 1.7] P=0.0004 for the total number of symptoms and the number of symptoms causing discomfort, respectively). No baseline differences and no significant changes were observed in the six QOL scores. The percentage of patients with a positive perception of their global health status increased significantly in the monotherapy arm from 32% at baseline to 67% at week 48 ( P<0.0001). Conclusions These results suggest that the number of self-reported symptoms could be used as a treatment-sensitive measure of patients’ well-being in clinical trials.
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Affiliation(s)
- Bruno Spire
- INSERM U912 ‘Economic & Social Sciences, Health Systems & Societies’, Marseilles, France
- IRD, UMR-S912, Faculté de Médecine, Aix-Marseilles Université, Marseilles, France
- Southeastern Health Regional Observatory (ORS-PACA), Marseilles, France
| | - Fabienne Marcellin
- INSERM U912 ‘Economic & Social Sciences, Health Systems & Societies’, Marseilles, France
- IRD, UMR-S912, Faculté de Médecine, Aix-Marseilles Université, Marseilles, France
- Southeastern Health Regional Observatory (ORS-PACA), Marseilles, France
| | | | | | - Francois Boue
- A Beclere Hospital, Université Paris-Sud 11, Clamart, France
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Moatti JP, Spire B. Editorial: HIV/AIDS: a long-term research agenda for social sciences. AIDS Care 2008; 20:407-12. [DOI: 10.1080/09540120801942776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jean-Paul Moatti
- a INSERM/IRD/University of the Mediterranean Research Unit 912 (Economic & Social Sciences, Health Systems, Societies)
- b ORS-PACA (Regional Centre for Diseases Control of South Eastern France)
| | - Bruno Spire
- a INSERM/IRD/University of the Mediterranean Research Unit 912 (Economic & Social Sciences, Health Systems, Societies)
- b ORS-PACA (Regional Centre for Diseases Control of South Eastern France)
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Prevalence and Predictors of Deterioration of a Trustful Patient-Provider Relationship Among HIV-Infected Persons Treated With Antiretroviral Therapy. J Acquir Immune Defic Syndr 2008; 47:467-71. [DOI: 10.1097/qai.0b013e31815f3bdc] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mannheimer SB, Wold N, Gardner EM, Telzak EE, Huppler Hullsiek K, Chesney M, Wu AW, MacArthur RD, Matts J, Friedland G. Mild-to-moderate symptoms during the first year of antiretroviral therapy worsen quality of life in HIV-infected individuals. Clin Infect Dis 2008; 46:941-5. [PMID: 18279044 DOI: 10.1086/528859] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Symptoms and quality of life were assessed among human immunodeficiency virus (HIV)-infected individuals initiating their first course of antiretroviral therapy. Symptoms, which were mostly mild or moderate, were common in the first year and significantly affected the patients' quality of life. Quality of life was inversely related to the number of symptoms and in the change in the number of symptoms from baseline.
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Affiliation(s)
- Sharon B Mannheimer
- Division of Infectious Diseases, Harlem Hospital Center, New York, New York, USA.
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Schackman BR, Ribaudo HJ, Krambrink A, Hughes V, Kuritzkes DR, Gulick RM. Racial differences in virologic failure associated with adherence and quality of life on efavirenz-containing regimens for initial HIV therapy: results of ACTG A5095. J Acquir Immune Defic Syndr 2007; 46:547-54. [PMID: 18193496 DOI: 10.1097/qai.0b013e31815ac499] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blacks had higher rates of virologic failure than whites on efavirenz-containing regimens in the AIDS Clinical Trials Group (ACTG) A5095 study; preliminary analyses also suggested an association with adherence. We rigorously examined associations over time among race, virologic failure, 4 self-reported adherence metrics, and quality of life (QOL). METHODS ACTG A5095 was a double-blind placebo-controlled study of treatment-naive HIV-positive patients randomized to zidovudine/lamivudine/abacavir versus zidovudine/lamivudine plus efavirenz versus zidovudine/lamivudine/abacavir plus efavirenz. Virologic failure was defined as confirmed HIV-1 RNA >or=200 copies/mL at >or=16 weeks on study. The zidovudine/lamivudine/abacavir arm was discontinued early because of virologic inferiority. We examined virologic failure differences for efavirenz-containing arms according to missing 0 (adherent) versus at least 1 dose (nonadherent) during the past 4 days, alternative self-reported adherence metrics, and QOL. Analyses used the Fisher exact, log rank tests, and Cox proportional hazards models. RESULTS The study population included white (n = 299), black (n = 260), and Hispanic (n = 156) patients with >or=1 adherence evaluation. Virologic failure was associated with week 12 nonadherence during the past 4 days for blacks (53% nonadherent failed vs. 25% adherent; P < 0.001) but not for whites (20% nonadherent failed vs. 20% adherent; P = 0.91). After adjustment for baseline covariates and treatment, there was a significant interaction between race and week 12 adherence (P = 0.02). In time-dependent Cox models using self-reports over time to reflect recent adherence, there was a significantly higher failure risk for nonadherent subjects (hazard ratio [HR] = 2.07; P < 0.001). Significant race-adherence interactions were seen in additional models of adherence: missing at least 1 medication dose ever (P = 0.04), past month (P < 0.01), or past weekend (P = 0.05). Lower QOL was significantly associated with virologic failure (P < 0.001); there was no evidence of an interaction between QOL and race (P = 0.39) or adherence (P = 0.51) in predicting virologic failure. CONCLUSIONS There was a greater effect of nonadherence on virologic failure in blacks given efavirenz-containing regimens than in whites. Self-reported adherence and QOL are independent predictors of virologic failure.
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Affiliation(s)
- Bruce R Schackman
- Department of Public Health, Weill Medical College, New York, NY 10021, USA.
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