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Mulligan K, Harris K, Rixon L, Burls A. A systematic mapping review of clinical guidelines for the management of fatigue in long-term physical health conditions. Disabil Rehabil 2024:1-18. [PMID: 38832888 DOI: 10.1080/09638288.2024.2353855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/04/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Despite a high prevalence of fatigue and its importance to patients, many people with long-term conditions do not receive fatigue management as part of their treatment. This review is aimed to identify clinical guidance for the management of fatigue in long-term physical health conditions. METHODS A systematic mapping review was conducted in accordance with Social Care Institute for Excellence systematic review guidance. Bibliographic databases and guideline repositories were searched for clinical guidelines for long-term conditions, published between January 2008 and July 2018, with a search for updates conducted in May 2023. Data were extracted on the recommendations made for managing fatigue and, where cited, the underlying research evidence used to support these recommendations was also extracted. RESULTS The review included 221 guidelines on 67 different long-term conditions. Only 30 (13.6%) of the guidelines contained recommendations for managing fatigue. These were categorised as clinical (e.g. conduct further investigations), pharmacological, behavioural (e.g. physical activity), psychological, nutritional, complementary, environmental, and multicomponent. The guidelines rated much of the evidence for fatigue management as fairly low quality, highlighting the need to develop and test fatigue-management strategies in high-quality trials. CONCLUSION This review highlights that management of fatigue is a very important neglected area in the clinical guidelines for managing long-term conditions.
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Affiliation(s)
- Kathleen Mulligan
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katherine Harris
- Centre for Genomics and Child Health, the Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Lorna Rixon
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Amanda Burls
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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2
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Hu LY, Cai AQ, Li B, Li Z, Liu JP, Cao HJ. Chinese herbal medicine for post-viral fatigue: A systematic review of randomized controlled trials. PLoS One 2024; 19:e0300896. [PMID: 38512808 PMCID: PMC10956782 DOI: 10.1371/journal.pone.0300896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Fatigue is a common symptom after viral infection. Chinese herbal medicine (CHM) is thought to be a potential effective intervention in relieving fatigue. PURPOSE To assess the effectiveness and safety of CHM for the treatment of post-viral fatigue. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS The protocol of this systematic review was registered on PROSPERO (CRD42022380356). Trials reported changes of fatigue symptom, which compared CHM to no treatment, placebo or drugs, were included. Six electronic databases and three clinical trial registration platforms were searched from inception to November 2023. Literature screening, data extraction, and risk bias assessment were independently carried out by two reviewers. Quality of the included trials was evaluated using Cochrane risk of bias tool, and the certainty of the evidence was evaluated using GRADE. The meta-analysis was performed using Review Manager 5.4, mean difference (MD) and its 95% confidence interval (CI) was used for estimate effect of continuous data. Heterogeneity among trials was assessed through I2 value. RESULTS Overall, nineteen studies with 1921 patients were included. Results of individual trial or meta-analysis showed that CHM was better than no treatment (MD = -0.80 scores, 95%CI -1.43 to -0.17 scores, P = 0.01, 60 participants, 1 trial), placebo (MD = -1.90 scores, 95%CI -2.38 to -1.42 scores, P<0.00001, 184 participants, 1 trial), placebo on basis of rehabilitation therapy (MD = -14.90 scores, 95%CI -24.53 to -5.27 scores, P = 0.02, 118 participants, 1 trial) or drugs (MD = -0.38 scores, 95%CI -0.48 to -0.27 scores, I2 = 0%, P<0.00001, 498 participants, 4 trials) on relieving fatigue symptoms assessing by Traditional Chinese Medicine fatigue scores. Trials compared CHM plus drugs to drugs alone also showed better effect of combination therapy (average MD = -0.56 scores). In addition, CHM may improve the percentage of CD4 T lymphocytes and reduce the level of serum IL-6 (MD = -14.64 scores, 95%CI 18.36 to -10.91 scores, I2 = 0%, P<0.00001, 146 participants, 2 trials). CONCLUSION Current systematic review found that the participation of CHM can improve the symptoms of post-viral fatigue and some immune indicators. However, the safety of CHM remains unknown and large sample, high quality multicenter RCTs are still needed in the future.
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Affiliation(s)
- Le-Yan Hu
- Beijing University of Chinese Medicine, Beijing, China
| | - An-Qi Cai
- Beijing University of Chinese Medicine, Beijing, China
| | - Bo Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Zheng Li
- Traditional Chinese Medicine Hospital affiliated to Xinjiang Medical University, Ürümqi, Xinjiang, China
| | - Jian-Ping Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Hui-Juan Cao
- Beijing University of Chinese Medicine, Beijing, China
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3
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Skogen V, Langseth R, Rohde GE, Rysstad O, Sørlie T, Lie B. Prevalence of mental distress and factors associated with symptoms of major depression among people living with HIV in Norway. AIDS Care 2024; 36:173-180. [PMID: 37909108 DOI: 10.1080/09540121.2023.2275043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
For people living with HIV (PLHIV) who can access lifesaving treatment, HIV has become a chronic lifelong condition; however, PLHIV have more mental and somatic comorbidities than their HIV-negative peers. In this cross-sectional study, we assessed the prevalence of mental distress and identified factors associated with major depression among 244 well-treated PLHIV residing in Norway. Participants completed validated questionnaires covering mental and somatic health. The prevalence of mental distress, defined as a score on the Hopkins Symptom Check List-25 >1.75, was 32%, and that of symptoms of major depression, defined as a score on the Beck Depression Inventory-II ≥20, was 15%. The factors associated with major depressive symptoms identified using logistic regression were risk of drug abuse (adjusted odds ratio (AOR) 15.1, 95% confidence interval (CI) 3.28, 69.3), fatigue (AOR 12.5, 95% CI 3.90, 40.0), trouble sleeping (AOR 7.90, 95% CI 2.85, 21.9), African origin (AOR 3.90, 95% CI 1.28, 11.9), low education (AOR 3.31, 95% CI 1.18, 9.30), and non-disclosure (AOR 3.22, 95% CI 1.04, 10.0). Our findings indicate that the prevalence rates of mental distress and major depressive symptoms are higher among well-treated PLHIV residing in Norway than in the general population. These conditions are under-diagnosed and under-treated, and increased awareness is needed.
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Affiliation(s)
- Vegard Skogen
- Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromso, Norway
- Institute for Clinical Medicine, University of Tromso - The Arctic University of Norway, Tromso, Norway
| | - Ranveig Langseth
- Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromso, Norway
| | - Gudrun E Rohde
- Department of Clinical Research, Hospital of Southern Norway, Kristiansand, Norway
- Faculty of Health & Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ole Rysstad
- Department of Internal Medicine, Hospital of Southern Norway, Kristiansand, Norway
| | - Tore Sørlie
- Institute for Clinical Medicine, University of Tromso - The Arctic University of Norway, Tromso, Norway
- Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromso, Norway
| | - Birgit Lie
- Department of Psychosomatic and Trauma, Hospital of Southern Norway, Kristiansand, Norway
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4
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Darquenne C, Theilmann RJ, Rivoalen I, DeYoung PN, Orr JE, Malhotra A, Hicks CB, Owens RL. Upper airway imaging and function in obstructive sleep apnea in people with and without HIV. J Appl Physiol (1985) 2024; 136:313-321. [PMID: 38095015 PMCID: PMC11212802 DOI: 10.1152/japplphysiol.00750.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
Obstructive sleep apnea (OSA) is common in people living with human immunodeficiency virus (HIV) (PLWH), but the underlying mechanisms are unclear. With improved long-term survival among PLWH, aging and obesity are increasingly prevalent in this population. These are also strong risk factors for the development of obstructive sleep apnea. We used magnetic resonance imaging (MRI) to measure upper airway (UA) anatomy and tongue fat content in PLWH with OSA (PLWH + OSA, n = 9) and in age-, sex-, and body mass index (BMI)-matched OSA controls (OSA, n = 11). We also quantified change in UA dimension during tidal breathing (during wakefulness and natural sleep) at four anatomical levels from the hard palate to the epiglottis along with synchronous MRI-compatible electroencephalogram and nasal flow measurements. All participants underwent on a separate night a baseline polysomnogram to assess OSA severity and an additional overnight physiological sleep study to measure OSA traits. We found no difference between the PLWH + OSA and the OSA control group in UA volume [PLWH + OSA: 12.8 mL (10.1-17.0), OSA: 14.0 mL (13.3-17.9), median (IQR)] or tongue volume [PLWH + OSA: 140.2 mL (125.1-156.9), OSA: 132.4 mL (126.8-154.7)] and a smaller tongue fat content in PLWH + OSA [11.2% (10.2-12.4)] than in the OSA controls [14.8% (13.2-15.5), P = 0.046]. There was no difference in the dynamic behavior of the UA between the two groups. When pooled together, both static and dynamic imaging metrics could be correlated with measures of UA mechanical properties. Our data suggest similar underlying UA physiology in OSA in subjects with and without HIV.NEW & NOTEWORTHY Obstructive sleep apnea is common in people living with human immunodeficiency virus (HIV), but the underlying mechanisms are unclear. We did not find differences in upper airway morphology using magnetic resonance imaging (MRI) during wake and natural sleep between people living with HIV (PLWH) with obstructive sleep apnea (OSA) and age, gender, and body mass index (BMI)-matched people with OSA but without HIV. Nor were there differences in tongue volume or changes in airway size during inspiration and expiration. MRI-derived anatomy was correlated with measures of airway collapse.
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Affiliation(s)
- Chantal Darquenne
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, California, United States
| | - Rebecca J Theilmann
- Department of Radiology, University of California, San Diego, California, United States
| | - Ines Rivoalen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, California, United States
| | - Pamela N DeYoung
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, California, United States
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, California, United States
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, California, United States
| | - Charles B Hicks
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, United States
| | - Robert L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, California, United States
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Obeagu EI, Obeagu GU, Ukibe NR, Oyebadejo SA. Anemia, iron, and HIV: decoding the interconnected pathways: A review. Medicine (Baltimore) 2024; 103:e36937. [PMID: 38215133 PMCID: PMC10783375 DOI: 10.1097/md.0000000000036937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
This review delves into the intricate relationship between anemia, iron metabolism, and human immunodeficiency virus (HIV), aiming to unravel the interconnected pathways that contribute to the complex interplay between these 3 entities. A systematic exploration of relevant literature was conducted, encompassing studies examining the association between anemia, iron status, and HIV infection. Both clinical and preclinical investigations were analyzed to elucidate the underlying mechanisms linking these components. Chronic inflammation, a hallmark of HIV infection, disrupts iron homeostasis, impacting erythropoiesis and contributing to anemia. Direct viral effects on bone marrow function further compound red blood cell deficiencies. Antiretroviral therapy, while essential for managing HIV, introduces potential complications, including medication-induced anemia. Dysregulation of iron levels in different tissues adds complexity to the intricate network of interactions. Effective management of anemia in HIV necessitates a multifaceted approach. Optimization of antiretroviral therapy, treatment of opportunistic infections, and targeted nutritional interventions, including iron supplementation, are integral components. However, challenges persist in understanding the specific molecular mechanisms governing these interconnected pathways. Decoding the interconnected pathways of anemia, iron metabolism, and HIV is imperative for enhancing the holistic care of individuals with HIV/AIDS. A nuanced understanding of these relationships will inform the development of more precise interventions, optimizing the management of anemia in this population. Future research endeavors should focus on elucidating the intricate molecular mechanisms, paving the way for innovative therapeutic strategies in the context of HIV-associated anemia.
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Affiliation(s)
| | | | - Nkiruka Rose Ukibe
- Department of Medical Laboratory Science, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - Samson Adewale Oyebadejo
- Department of Biomedical Laboratory Sciences, Faculty of Fundamental Applied Sciences, Institut d’ Enseignement Superiuor de Ruhengeri (INES-RUHENGERI), Musanze District, Northern Region, Rwanda
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Tarantino N, Norman B, Enimil A, Asibey SO, Martyn-Dickens C, Guthrie KM, Kwara A, Bock B, Mimiaga MJ, Brown L. HIV symptom severity and associated factors among young people with HIV in Ghana. AIDS Care 2024:1-9. [PMID: 38184890 PMCID: PMC11227599 DOI: 10.1080/09540121.2023.2299332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACTAdolescents and young adults (young people) with HIV (YPWH) often struggle with treatment self-management. Many have symptoms due to HIV disease, medication side-effects, or comorbid conditions. Our study investigated the severity of HIV-related symptoms among YPWH aged 18-24 with detectable viral loads from an HIV clinic in Ghana (N = 60) and potential correlates of severity across a range of factors. Results indicated that YPWH currently experienced, on average, 13 symptoms (SD = 12.33). Six of the 10 most common symptoms were from two domains: fatigue and psychological. The most common symptoms were headaches (62%), weakness (53%), and fear/worries (52%). No differences were observed in number or severity of symptoms between youth based on HIV transmission status. Bivariate correlates of symptom severity were found with six that remained significant or approached significance in a multivariate model predicting severity: living with a parent/guardian, higher perceived access to HIV care, and higher treatment readiness were associated with lower severity while greater travel time to the HIV clinic, psychological distress, and more missed clinic appointments were associated with higher severity. Our findings suggest that interventions to address symptoms among YPWH should be multilevel and include strategies (e.g., telehealth, home care) to increase access to care.
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Affiliation(s)
- Nicholas Tarantino
- Providence College, Department of Psychology, Providence, RI, USA
- Rhode Island Hospital, Department of Psychiatry, Providence, RI, USA
| | - Betty Norman
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, Department of Medicine, Kumasi, Ghana
| | - Anthony Enimil
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, Department of Child Health, Kumasi, Ghana
| | | | | | - Kate M. Guthrie
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, USA
| | - Awewura Kwara
- University of Florida College of Medicine, Department of Medicine, Gainesville, FL, USA
| | - Beth Bock
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, USA
| | - Matthew J. Mimiaga
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Larry Brown
- Rhode Island Hospital, Department of Psychiatry, Providence, RI, USA
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, USA
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Zhong H, Wei F, Song Y, Chen H, Ni Z. Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study. Front Public Health 2023; 11:1133657. [PMID: 36992898 PMCID: PMC10040810 DOI: 10.3389/fpubh.2023.1133657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
PurposeThis study aimed to explore health-related quality of life (HRQoL) and its associated factors among people living with HIV/AIDS (PLWH) in Sichuan, China.MethodsA total of 401 PLWH were recruited from the city of Panzhihua between August 2018 and January 2019. Demographic characteristics and disease-related data were collected by self-administered questionnaires and medical system records. Health-related quality of life (HRQoL) was measured by the medical outcome study HIV health survey (MOS-HIV), which measured ten subdimensions and two summarized dimensions, the physical health summary score (PHS) and the mental health summary score (MHS). Logistic regression models were used to explore the variables independently associated with quality of life.ResultsThe PHS and MHS measured by MOS-HIV were 53.66 ± 6.80 and 51.31 ± 7.66, respectively. Younger age, higher educational level, no methadone use, higher CD4 lymphocyte counts, less symptom counts and heathy BMI significantly were associated with higher HRQOL in the univariate χ2-test analysis. Education level was found to have a significant influence on patients' quality of life, both in physical health (P = 0.022) and mental health (P = 0.002) dimensions. Younger age (P = 0.032), higher CD4 lymphocyte counts (P = 0.007), less symptom counts (P < 0.001) and health BMI level (P < 0.001) were positively related to the PHS of quality of life in the multivariable logistic regression model.ConclusionThe HRQoL of PLWH in Sinchuan Province was relatively low. Age, educational level, methadone use, CD4 lymphocyte counts, symptom counts and BMI were positively related to quality of life. This study indicates that health caregivers should pay more attention to comorbidity issues and mental health in PLWH, especially for those with lower education levels, unhealthy body mass index, more symptomatic presentation and older age.
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Affiliation(s)
- Hua Zhong
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fuling Wei
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuqing Song
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Chen
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Hong Chen
| | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- School of Nursing, Yale University, New Haven, CT, United States
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Sekine Y, Kawaguchi T, Kunimoto Y, Masuda J, Numata A, Hirano A, Yagura H, Ishihara M, Hikasa S, Tsukiji M, Miyaji T, Yamaguchi T, Kinai E, Amano K. Adherence to anti-retroviral therapy, decisional conflicts, and health-related quality of life among treatment-naïve individuals living with HIV: a DEARS-J observational study. J Pharm Health Care Sci 2023; 9:9. [PMID: 36859482 PMCID: PMC9979481 DOI: 10.1186/s40780-023-00277-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Supporting people living with HIV using anti-retroviral therapy (ART) is important due to the requirement for strict medication adherence. To date, no data from longitudinal studies evaluating adherence by treatment-naïve people living with HIV are currently available. We investigated the adherence of treatment-naïve people living with HIV over time and examined the relationships among decisional conflicts, adherence, and health-related quality of life (HRQL). METHODS The survey items included adherence (visual analogue scale [VAS]), decisional conflict (decisional conflict scale [DCS]), and HRQL (Medical Outcomes Study HIV Health Survey [MOS-HIV]). The DCS and MOS-HIV scores and the VAS and MOS scores were collected electronically at the ART initiation time point and at 4-, 24-, and 48-week post-treatment time points. RESULTS A total of 215 participants were enrolled. The mean DCS score was 27.3 (SD, 0.9); 23.3% of participants were in the high-score and 36.7% in the low-score groups. The mean adherence rates at 4, 24, and 48 weeks were 99.2% (standard error [SE], 0.2), 98.4% (SE, 0.4), and 96.0% (SE, 1.2), respectively. The least-square means of the MOS-HIV for the DCS (high vs. low scores) were 64.4 vs. 69.2 for general health perceptions and 57.7 vs. 64.0 for HRQL, respectively. CONCLUSION Adherence among treatment-naïve people living with HIV was maintained at a higher level, and HRQL tended to improve with ART. People with high levels of decisional conflict tended to have lower HRQL scores. Support for people living with HIV during ART initiation may be related to HRQL.
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Affiliation(s)
- Yusuke Sekine
- Department of Pharmacy, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Takashi Kawaguchi
- grid.410785.f0000 0001 0659 6325Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yusuke Kunimoto
- grid.470107.5Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Junichi Masuda
- grid.45203.300000 0004 0489 0290Department of Pharmacy, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Ayako Numata
- grid.45203.300000 0004 0489 0290Department of Pharmacy, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Hirano
- grid.410840.90000 0004 0378 7902Department of Pharmacy, National Hospital organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroki Yagura
- grid.416803.80000 0004 0377 7966Department of Pharmacy, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masashi Ishihara
- grid.411704.7Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Shinichi Hikasa
- grid.272264.70000 0000 9142 153XDepartment of Pharmacy, Hyogo Medical University Hospital, Hyogo, Japan
| | - Mariko Tsukiji
- grid.411321.40000 0004 0632 2959Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Tempei Miyaji
- grid.69566.3a0000 0001 2248 6943Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- grid.69566.3a0000 0001 2248 6943Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ei Kinai
- grid.410793.80000 0001 0663 3325Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kagehiro Amano
- grid.410793.80000 0001 0663 3325Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
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Wang D, Deng Q, Chen H, Wang M, Liu Z, Wang H, Ouyang X. Profiles of depressive symptoms and influential factors among people living with HIV in China. BMC Public Health 2023; 23:151. [PMID: 36690976 PMCID: PMC9869583 DOI: 10.1186/s12889-023-15057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Depressive symptoms are highly prevalent among people living with HIV (PLWH). We leveraged Latent Profile Analysis (LPA) to identify profiles of depressive symptoms among PLWHs. We also investigated differences in psychological factors of interest, demographic characteristics, and HIV-related factors across patients' profiles. METHODS A cross-sectional study was conducted at one hospital and two designated prison facilities in Hunan province, China. A total sample of 533 PLWHs (320 recruited from the hospital, 213 recruited from prisons) completed the survey. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). Family function, resilience, childhood trauma, demographic characteristics, and HIV-related factors were also evaluated. We conducted LPA and multinomial logistic regression analyses to: 1) identify distinct profiles for depressive symptoms; 2) identify demographic characteristics, and HIV-related, and psychological factors predicting PLWHs' likelihood to express a specific profile. RESULTS We identified three distinct profiles of depressive symptoms among PLWHs: severe symptoms (11.8%), moderate symptoms (40.5%), and low/no symptoms (47.7%). Moderate/ severe family dysfunction, low resilience, experiencing emotional abuse and neglect were more likely to fall in the "severe symptoms" rather than the "low/no symptoms" profile. In addition, severe family dysfunction, low resilience, and experiencing emotional neglect indicated a higher likelihood of being classified in the "moderate symptoms" profile, compared to the "low/no symptoms" profile. CONCLUSION Identifying profiles of depressive symptoms among PLWHs using the PHQ-9 items allows for understanding of the distinct paths of development of depressive symptoms and for developing tailored prevention and intervention programs for PLWHs.
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Affiliation(s)
- Dongfang Wang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Qijian Deng
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Huilin Chen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Min Wang
- Institute for HIV/AIDS, the First Hospital of Changsha, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
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Mwangala PN, Nasambu C, Wagner RG, Newton CR, Abubakar A. Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast. J Int AIDS Soc 2022; 25 Suppl 4:e25977. [PMID: 36176027 PMCID: PMC9522642 DOI: 10.1002/jia2.25977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/31/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Empirical research on the burden and determinants of common mental disorders (CMDs), especially depression and anxiety, among older adults living with HIV (OALWH) in sub-Saharan Africa is inadequate. To bridge the gap in Kenya we: (1) determined the prevalence of CMDs among OALWH on routine HIV care compared to HIV-negative peers; (2) investigated HIV status as an independent predictor of CMDs in older adults; and (3) investigated CMD determinants. METHODS In a cross-sectional study conducted between 2020 and 2021, the prevalence of CMDs and associated determinants were investigated at the Kenyan coast among 440 adults aged ≥50 years (257 OALWH). The Patient Health Questionnaire and Generalized Anxiety Disorder scale were administered alongside measures capturing biopsychosocial information. Logistic regression was used to examine the correlates of CMDs. RESULTS No significant differences were found in the prevalence of mild depressive symptoms, 23.8% versus 18.2% (p = 0.16) and mild anxiety symptoms, 11.7% versus 7.2% (p = 0.12) among OALWH compared to HIV-negative peers, respectively. HIV status was not independently predictive of CMDs. Among OALWH, higher perceived HIV-related stigma, ageism, increasing household HIV burden, loneliness, increasing functional disability, sleeping difficulties, chronic fatigue and advanced age (>70 years) were associated with elevated CMDs. Among HIV-negative older adults, loneliness, increased medication burden and sleeping difficulties were associated with elevated depressive symptoms. Easier access to HIV care was the only factor associated with lower CMDs among OALWH. CONCLUSIONS On the Kenyan coast, the burden of moderate and severe CMDs among older adults is low; however, both OALWH and their HIV-negative peers have a similar relatively high burden of mild depressive and anxiety symptoms. Our results also suggest that determinants of CMDs among OALWH in this setting are predominantly psychosocial factors. These results highlight the need for psychosocial interventions (at the family, community and clinical levels) to mitigate the risks of mild CMDs as they are known to be potentially debilitating.
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Affiliation(s)
- Patrick N. Mwangala
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya,School of Public HealthUniversity of the WitwatersrandParktownSouth Africa,Institute for Human DevelopmentAga Khan UniversityNairobiKenya
| | - Carophine Nasambu
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)Faculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
| | - Charles R. Newton
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya,Institute for Human DevelopmentAga Khan UniversityNairobiKenya,Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Department of Public HealthPwani UniversityKilifiKenya
| | - Amina Abubakar
- Centre for Geographic Medicine Research CoastKenya Medical Research Institute (KEMRI)KilifiKenya,Institute for Human DevelopmentAga Khan UniversityNairobiKenya,Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Department of Public HealthPwani UniversityKilifiKenya
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11
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Kaddu-Mulindwa D, Heit M, Wagenpfeil G, Bewarder M, Fassbender K, Behnke S, Yilmaz U, Fousse M. Fewer neurocognitive deficits and less brain atrophy by third ventricle measurement in PLWH treated with modern ART: A prospective analysis. Front Neurol 2022; 13:962535. [PMID: 36081869 PMCID: PMC9447481 DOI: 10.3389/fneur.2022.962535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite antiretroviral therapy, cognitive dysfunction seems to remain a major issue for people living with human immunodeficiency virus (PLWH). Previous studies showed a correlation between the width of the third ventricle (WTV) and neurocognitive disorders in PLWH. Patients and methods We investigated prevalence and correlation of neuropsychological disorders using WTV as a brain atrophy marker examined by transcranial sonography and MRI in PLWH and healthy age- and gender-matched controls. We used Becks Depression Inventory (BDI) for depression screening, the questionnaires Fatigue Severity Scale (FSS) for fatigue and Short-Form-36 (SF36) for quality of life (QoL) evaluation and Consortium to establish a registry for Alzheimer's disease (CERAD-PLUS) as neuropsychological test battery. Results 52 PLWH (47 males) and 28 non-infected controls (23 males) with a median age of 52 years (24–78 years) and 51 years (22–79) were analyzed. WTV correlated significantly with age (p < 0.01) but showed no significantly difference in PLWH (median = 3.4 mm) compared to healthy controls (median = 2.8 mm) (p = 0.085). PLWH had both significantly higher BDI-Scores (p = 0.005) and FSS-Scores (p = 0.012). Controls reported higher QoL (SF-36) with significant differences in most items. However, the overall cognitive performance (CERAD total score) showed no significant difference. The WTV of all subjects correlated with neurocognitive performance measured as CERAD total score (p = 0.009) and trail making tests A (p < 0.001) and B (p = 0.018). There was no correlation between the scores of BDI, FSS, SF-36, and CERAD-PLUS items and WTV. Conclusion WTV is considered as a predictor of cognitive deficits in neurodegenerative diseases. Nevertheless, we found no significant difference in WTV or overall cognitive performance between PLWH and controls. PLWH suffer more often from depression and fatigue and report reduced QoL when compared to healthy controls.
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Affiliation(s)
- Dominic Kaddu-Mulindwa
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Matthias Heit
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometrics, Epidemiology and Medical Computer Science, Saarland University Medical School, Homburg, Germany
| | - Moritz Bewarder
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical School, Homburg, Germany
| | - Stefanie Behnke
- Department of Neurology, Saarland University Medical School, Homburg, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Medical School, Homburg, Germany
| | - Mathias Fousse
- Department of Neurology, Saarland University Medical School, Homburg, Germany
- *Correspondence: Mathias Fousse
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12
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Campbell LM, Sun-Suslow N, Heaton A, Heaton RK, Ellis RJ, Moore DJ, Moore RC. Fatigue is associated with worse cognitive and everyday functioning in older persons with HIV. AIDS 2022; 36:763-772. [PMID: 34999606 PMCID: PMC9081180 DOI: 10.1097/qad.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether there are relationships between fatigue, cognition, and everyday functioning in older persons with and without HIV and to examine if associations remain after accounting for depression, anxiety, and sleep quality. METHODS Sixty-nine persons with HIV (PWH) and 36 persons without HIV, aged 50-74 years, were recruited from ongoing studies at UC San Diego's HIV Neurobehavioral Research Program and from the community. Participants completed neuropsychological testing, a performance-based measure of everyday functioning, and self-report questionnaires of fatigue, depression, anxiety, sleep quality, and everyday functioning. Multivariable linear regressions and logistic regressions stratified by HIV serostatus were used to examine relationships between fatigue, cognition, and everyday functioning. Psychiatric symptoms and sleep quality were examined as covariates. RESULTS In this cross-sectional study, PWH had significantly greater fatigue than the HIV-negative group (g = 0.83; P < 0.01). When stratifying by HIV serostatus, greater fatigue was significantly associated with worse global cognition (β = -0.56;P < 0.01) in PWH even when controlling for covariates;however, fatigue was not significantly associated with global cognition in persons without HIV. In PWH and when accounting for covariates, fatigue was also associated with greater risk of self-reported everyday functioning impairment [odds ratio (OR) = 1.66 for 10-point increase in fatigue, P = 0.04] but not performance-based everyday functioning (P = 0.95). CONCLUSION Fatigue is associated with cognition, particularly measures with a speeded component, and self-reported everyday functioning in older PWH. Findings suggest that fatigue is important to assess and consider in the context of aging with HIV.
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Affiliation(s)
- Laura M Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ni Sun-Suslow
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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13
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Oliveira VHF, Erlandson KM, Cook PF, Jankowski C, MaWhinney S, Dirajlal-Fargo S, Knaub L, Hsiao CP, Horvat Davey C, Webel AR. The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH): A Research Protocol. J Assoc Nurses AIDS Care 2022; 33:178-188. [PMID: 34039876 PMCID: PMC8613312 DOI: 10.1097/jnc.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH), which incorporates an exercise and biobehavioral coaching intervention, has the following overall goals: (a) to determine whether high-intensity interval training (HIIT) mitigates physical function impairments, fatigue, and impairments in mitochondrial bioenergetics of older people living with HIV (PLWH) to a greater extent than continuous moderate exercise (CME); and (b) to determine whether a biobehavioral coaching and mobile health text messaging intervention after HIIT or CME can promote long-term adherence to physical activity. The HEALTH study is a randomized trial of 100 older PLWH (≥50 years of age) who self-report fatigue and have a sedentary lifestyle. Enrolled participants will be randomized to 16 weeks of supervised HIIT or CME training, followed by a 12-week maintenance phase, involving a mobile health coaching intervention. Outcomes of the HEALTH study will inform the development of scalable, effective exercise recommendations tailored to the unique needs of aging PLWH.
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Affiliation(s)
- Vitor H F Oliveira
- Vitor H. F. Oliveira, PhD, is an Acting Instructor, University of Washington, School of Nursing, Seattle, Washington, USA. Kristine M. Erlandson, MD, MS, is an Associate Professor, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Paul F. Cook, PhD, is an Associate Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, Colorado, USA. Catherine Jankowski, PhD, is an Associate Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, Colorado, USA. Samantha MaWhinney, ScD, is a Professor, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Sahera Dirajlal-Fargo, DO, MS, is an Assistant Professor, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA. Leslie Knaub, MS, is a Senior Professional Research Assistant, University of Colorado Anschutz Medical Campus, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA. Chao-Pin Hsiao, RN, PhD, FAAN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. Christine Horvat Davey, RN, PhD, is a Research Associate and Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. Allison R. Webel, RN, PhD, FAAN, is a Professor and Associate Dean for Research, University of Washington, School of Nursing, Seattle, Washington, USA
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14
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Jong S, Lee KA, Gay CL. Daytime and nighttime correlates of fatigue and lack of energy in adults living with HIV. Chronic Illn 2021; 17:463-474. [PMID: 31707796 DOI: 10.1177/1742395319884110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe correlates of fatigue and lack of energy symptoms in adults living with HIV. METHODS Adults living with HIV were recruited if they were ≥45 years old, unemployed, and reported either fatigue or lack of energy in the past week. HIV-associated correlates included CD4 cell count, viral load, and hemoglobin. Daytime correlates included physical activity, daytime sleepiness, napping behavior, and symptoms of anxiety and depression. Nighttime correlates included use of sleep medication, sleep duration, and sleep quality. Outcomes included physical and cognitive function. RESULTS Most (70%) of the 53 participants were male. The mean age was 56.7 ± 6.7 years and participants had been living with HIV for a mean of 22 ± 6.4 years. Controlling for all other factors, African Americans reported less fatigue and more energy than other racial/ethnic groups. Lack of energy was associated with daytime napping and cognitive function. Fatigue was associated with shorter nighttime sleep duration, anxiety, and both physical and cognitive function. DISCUSSION Findings highlight potential differences between lack of energy and fatigue that could influence intervention outcomes. Avoiding daytime naps and encouraging longer nighttime sleep may improve fatigue as well as physical and cognitive function in this chronic illness population.
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Affiliation(s)
- SoSon Jong
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA.,Lovisenberg Diakonale Hospital, Oslo, Norway
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15
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Ter Haar AM, der Vlist MMNV, Van den Hof M, Nijhof SL, van Litsenburg RRL, Oostrom KJ, Pajkrt D. Fatigue in children and adolescents perinatally infected with human immunodeficiency virus: an observational study. BMC Pediatr 2021; 21:519. [PMID: 34798840 PMCID: PMC8605599 DOI: 10.1186/s12887-021-02977-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/27/2021] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Fatigue is common among adults living with human immunodeficiency virus (HIV) as well as children with a chronic disease (CCD). Fatigue can have disastrous effects on health status, including health related quality of life (HRQOL). Even so, fatigue is underexplored in children and adolescents perinatally infected with HIV (PHIV+) in the Netherlands. The objective of this observational study is to explore fatigue in PHIV+ and its association with their HRQOL. METHODS We measured HRQOL and fatigue using the Pediatric Quality of Life Inventory™ (PedsQL 4.0) and the PedsQL Multidimensional Fatigue Scale (MFS). The PedsQL MFS encompasses three subscales: general fatigue, sleep/rest fatigue and cognitive fatigue, and a total fatigue score. We compared outcomes of PHIV+ children and adolescents in the Amsterdam University Medical Centre with three groups: 1) HIV-uninfected controls (HIV-) matched for age, sex, region of birth, socioeconomic status and adoption status, 2) CCD, and 3) the general Dutch population. Within the PHIV+ group we explored associations between fatigue and HRQOL. RESULTS We enrolled 14 PHIV+ (median age 10.2 years [IQR 9.2-11.4]) and 14 HIV-. Compared to CCD, PHIV+ significantly reported less general fatigue (mean difference 13.0, 95% CI 1.3 to 24.8). PHIV+ did not score significantly different on any of the other PedsQL MFS scales compared to HIV-, CCD or the general Dutch population. PHIV children scored relatively low on the cognitive fatigue scale in comparison to HIV-uninfected matched controls, CCD and the general population, although these differences did not reach significance. Among PHIV+, a lower score on total fatigue, general fatigue and cognitive fatigue was associated with a lower HRQOL score. CONCLUSIONS The results of this study suggest that PHIV children and adolescents do not experience more symptoms of fatigue than their healthy peers. However, PHIV children and adolescents may be more likely to experience cognitive fatigue. Fatigue in PHIV also appears to be associated with children's HRQOL. Further research should confirm these exploratory findings.
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Affiliation(s)
- A M Ter Haar
- Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - M M Nap-van der Vlist
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M Van den Hof
- Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - S L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - R R L van Litsenburg
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - K J Oostrom
- Psychosocial Department, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D Pajkrt
- Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
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16
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Mifsud S, Gauci Z, Gruppetta M, Mallia Azzopardi C, Fava S. Adrenal insufficiency in HIV/AIDS: a review. Expert Rev Endocrinol Metab 2021; 16:351-362. [PMID: 34521306 DOI: 10.1080/17446651.2021.1979393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/24/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Adrenal insufficiency (AI) is one of the most common potentially life-threatening endocrine complications in people living with human immunodeficiency virus (PLHIV) infection and acquired immunodeficiency syndrome (AIDS). AREAS COVERED In this review, the authors explore the definitions of relative AI, primary AI, secondary AI and peripheral glucocorticoid resistance in PLHIV. It also focuses on the pathophysiology, etiology, diagnosis and management of this endocrinopathy in PLHIV. A literature review was conducted through Medline and Google Scholar search on the subject. EXPERT OPINION Physicians need to be aware of the endocrinological implications of HIV infection and its treatment, especially CYP3A4 enzyme inhibitors. A high index of clinical suspicion is needed in the detection of AI, especially in PLHIV, as it may present insidiously with nonspecific signs and symptoms and may be potentially life threatening if left untreated. Patients with overt primary and secondary AI require glucocorticoid replacement therapy. Overt primary AI also necessitates mineralocorticoid replacement. On the other hand, the management of relative AI remains controversial. In order to reduce the risk of adrenal crisis during periods of stress, the short-term use of glucocorticoids may be necessary in relative AI.
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Affiliation(s)
- Simon Mifsud
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
| | - Zachary Gauci
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
| | - Mark Gruppetta
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Stephen Fava
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
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17
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Zhang Q, Li X, Qiao S, Liu S, Shen Z, Zhou Y. Association between hair cortisol, hair cortisone, and fatigue in people living with HIV. Stress 2021; 24:772-779. [PMID: 33913374 DOI: 10.1080/10253890.2021.1919616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Cumulative evidence to date largely supports an association between dysregulation of the activity of the hypothalamic-pituitary-adrenal (HPA) axis and fatigue. People living with HIV (PLHIV), in particular, are vulnerable to both HPA axis dysregulation and fatigue. Few investigations have examined the possible role of HPA-axis dysfunction in the occurrence of fatigue in PLHIV. This cross-sectional study aimed to investigate the association between glucocorticoids in hair, retrospective indicators of long-term HPA axis activity and biomarkers of chronic stress, and fatigue in PLHIV. A total of 446 PLHIV from Guangxi China provided hair samples for cortisol and cortisone assay and provided information on fatigue levels, sociodemographic, lifestyle, and HIV-related characteristics. Results showed that before and after controlling sociodemographic, lifestyle, and HIV-related characteristics, hair cortisone levels, but not hair cortisol levels, were associated with fatigue levels in PLHIV. In conclusion, we found that higher cortisone levels are associated with greater fatigue levels in a large cohort of Chinese PLHIV.LAY SUMMARYWe found that hair cortisone levels were significantly associated with fatigue levels in a large cohort of Chinese PLHIV. Hair cortisol levels were, however, not associated with fatigue levels in the PLHIV studied. We thus show that Chinese PLHIV who have higher cortisone levels are associated with higher fatigue levels.
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Affiliation(s)
- Quan Zhang
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Institute of Pedagogy and Applied Psychology, School of Public Administration, Hohai University, Nanjing, China
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shuaifeng Liu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
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18
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Voss JG, Barroso J, Wang T. A Critical Review of Symptom Management Nursing Science on HIV-Related Fatigue and Sleep Disturbance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010685. [PMID: 34682431 PMCID: PMC8535986 DOI: 10.3390/ijerph182010685] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022]
Abstract
Despite improved antiretroviral treatments, people living with HIV (PLWH) continue to suffer from HIV-related fatigue and sleep disturbances. We first reviewed the definition, etiology, and research breakthroughs of HIV-related fatigue and sleep disturbances, then analyzed nurse-led symptom management studies to describe their efficacy and make recommendations for future symptom research. We searched PubMed, CINAHL, PsycInfo, Psych and Behavioral Sciences Collection, and Scopus to identify nurse-led studies on symptom management for PLWH in the past 20 years. A total of 13 experimental or quasi-experimental studies were identified. The types of interventions included exercise, cognitive behavioral therapy, coaching, and symptom management manualized self-care activities. Currently, we cannot recommend with certainty any of the tested symptom management strategies to reduce fatigue or sleep disturbances. The current findings need to be confirmed and expanded to understand optimal dosing and sustainability.
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Affiliation(s)
- Joachim G. Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Julie Barroso
- School of Nursing, Vanderbilt University, Nashville, TN 37240, USA;
| | - Tongyao Wang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA;
- School of Nursing, Fudan University, Shanghai 200032, China
- Correspondence:
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19
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Hughes AM, Campbell L, Graham H, Post F, Chalder T. A Biopsychosocial Approach to HIV Fatigue: A Cross-Sectional and Prospective Analysis to Identify Key Modifiable Factors. Behav Med 2021; 47:205-213. [PMID: 32078500 DOI: 10.1080/08964289.2020.1712582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This study aimed to identify the prevalence and predictors of current fatigue and fatigue at 1-year follow-up, in people with HIV. Participants were recruited from HIV outpatient clinics in London, England. We explored a range of bio-psychosocial factors associated with current fatigue severity, identifying the most salient factors in a multifactorial model. A prospective study explored the predictive value of specific psychological and behavioral factors in predicting fatigue severity at one year. Sixty-four of 131 (49%) participants met the criteria for clinically significant fatigue at baseline. Psychological and behavioral variables, but not immune-virologic markers or antiretroviral treatment, were associated with current fatigue severity. In the multifactorial model, catastrophizing and distress independently predicted current fatigue severity. Higher levels of fatigue at 1 year was predicted by baseline catastrophizing, symptom focusing, distress and sleep quality, when controlling for baseline fatigue, clinical and demographic variables. These findings suggest psychological and behavioral factors are important in the maintenance of fatigue in people with HIV and identify potential opportunities for treatment. Future interventions for fatigue in HIV should not only address anxiety, depression and distress but could be optimized by targeting psychological processes such as catastrophic thinking styles and symptom focusing.
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Affiliation(s)
- Alicia M Hughes
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
| | - Lucy Campbell
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
| | - Hannah Graham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
| | - Frank Post
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, King's College London
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20
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Langseth R, Berg RC, Rysstad O, Sørlie T, Lie B, Skogen V. Prevalence and predictors of fatigue among people living with HIV in Norway. AIDS Care 2021; 34:1008-1013. [PMID: 34074179 DOI: 10.1080/09540121.2021.1934379] [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
Fatigue is the most commonly noted symptom among people living with human immunodeficiency virus (PLHIV). The aim of this study was to investigate the prevalence and predictors of fatigue among PLHIV in Norway. Two hundred and forty-four people were recruited from two hospitals to participate in a survey, which contained seven instruments used to investigate mental health, addiction, quality of life, and fatigue. More than a third of the participants (38.5%) suffered from fatigue. Predictors of fatigue were the presence of mental distress (adjusted odds ratio [AOR] 8.98, 95%CI 3.81, 21.15), multimorbidity (AOR 5.13, 95%CI 1.40, 18.73), living alone (AOR 2.99, 95%CI 1.36, 6.56), trouble sleeping (AOR 2.67, 95%CI 1.06, 6.71), and increased body pain (AOR 1.44, 95%CI 1.25, 1.67). To improve the quality of life for many PLHIV, the continuum of HIV care must address fatigue and its predictors.
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Affiliation(s)
- Ranveig Langseth
- Department of Infectious Diseases, Medical clinic, University Hospital of North Norway, Tromso, Norway.,Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromso, Norway
| | - Rigmor C Berg
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromso, Norway.,Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Ole Rysstad
- Department of Internal Medicine, Hospital of Southern Norway, Kristiansand, Norway
| | - Tore Sørlie
- Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromso, Norway.,Institute for Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromso, Norway
| | - Birgit Lie
- Department of Psychosomatic and Trauma, Hospital of Southern Norway, Kristiansand, Norway
| | - Vegard Skogen
- Department of Infectious Diseases, Medical clinic, University Hospital of North Norway, Tromso, Norway.,Institute for Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromso, Norway
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Abstract
Approximately 30-50% of persons living with HIV manifest some degree of neurocognitive impairment. Even mild-to-moderate forms of HIV-associated neurocognitive disorders (HAND) can result in difficulties with everyday functioning, such as suboptimal medication adherence and impaired driving. Despite the pervasive presence and consequences of HAND, there is a significant unmet need to develop effective behavioral strategies to reduce the incidence and consequences of HAND. Although there is an absence of evidence-based behavioral interventions specific to HAND, the literature reviewed in this chapter suggest the following modifiable lifestyle factors as intervention targets: physical activity, diet, sleep, and antiretroviral medication adherence. Adoption and maintenance of these healthy lifestyle factors may reduce inflammation and oxidative stress, which, in turn, may reduce the incidence and/or severity of HAND.
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Affiliation(s)
- Jessica L Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brook Henry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
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22
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Vold JH, Gjestad R, Aas CF, Chalabianloo F, Skurtveit S, Løberg EM, Johansson KA, Fadnes LT. Impact of clinical and sociodemographic factors on fatigue among patients with substance use disorder: a cohort study from Norway for the period 2016-2020. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:93. [PMID: 33317568 PMCID: PMC7737389 DOI: 10.1186/s13011-020-00334-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/10/2022]
Abstract
Background The impact of clinical and sociodemographic factors on fatigue remains unknown among patients with substance use disorders (SUD). This study aims to evaluate fatigue among patients with SUD using a nine-item fatigue severity scale (FSS-9) and identify the impact that clinical and sociodemographic factors – such as injecting substance use, chronic infectious diseases, liver fibrosis, opioid agonist therapy (OAT), debt difficulties, and housing situation – have on fatigue. Methods We used data from a cohort of patients with SUD in Norway with annual health assessments surveying FSS-9 and some clinical and sociodemographic factors. A total of 915 FSS-9 measurements were collected from 654 patients during the period 2016–2020. We defined baseline as the first annual health assessment when the health assessments were listed chronologically. Time was defined as years from baseline. We used a linear mixed model to analyse whether the clinical and sociodemographic factors affected the FSS-9 sum score, presented with beta coefficients (β) with 95% confidence intervals (CI). Results The mean sum score of the FSS-9 was 43 (standard deviation: 16) at baseline. Females compared with males (adjusted mean difference of FSS-9 sum score: 4.1, 95% CI: 1.3–7.0), having debt difficulties compared with having no debt difficulties (2.9;0.4–5.3), and frequent use of benzodiazepines (5.7;3.0–8.4) or amphetamines (-5.0;-8.0– -2.0) compared to less frequent or no use of these substances changed the FSS-9 baseline sum score. The other clinical and sociodemographic factors did not predict any clinically relevant change in the FSS-9 sum score from baseline to the following health assessments. Conclusion Patients with SUD suffer from high levels of fatigue. Female patients, patients with debt difficulties, and those with extensive use of benzodiazepines are at particular risk of being fatigued. This should be taken into consideration when planning health services. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-020-00334-x.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Rolf Gjestad
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Christer F Aas
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Else-Marie Løberg
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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23
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Baye M, Fisseha B, Bayisa M, Abebe SM, Janakiraman B. Experience of fatigue and associated factors among adult people living with HIV attending ART clinic: a hospital-based cross-sectional study in Ethiopia. BMJ Open 2020; 10:e042029. [PMID: 33087381 PMCID: PMC7580062 DOI: 10.1136/bmjopen-2020-042029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study aimed to determine the prevalence of fatigue and the factors associated among adult people living with HIV attending antiretroviral therapy clinic in Gondar town, Ethiopia. DESIGN Cross-sectional. SETTING Governmental health facility that provides HIV care in Gondar town. OUTCOME MEASURE Fatigue is defined by nine items version Fatigue Severity Scale. PARTICIPANTS Adult (aged 18 and above) people living with HIV in Gondar town (n=392). RESULT A total of 408 HIV seropositive adults were approached for consent, among which 392 participants consented to participate in this study, with a response rate of 96.1%. The mean age of the participants was 40.5±8.5 years. The prevalence of HIV-related fatigue was 53.3% and about 66% of women living with HIV experienced fatigue. The factors associated with fatigue experience were; female gender (adjusted OR (AOR): 2.61, 95% CI 1.01 to 5.3), being married (AOR: 0.18, 95% CI 0.10 to 0.9), low income (AOR: 7.1, 95% CI 4.6 to 22.15), unemployed (AOR: 2.79, 95% CI 1.19 to 9.84), parity (AOR: 4.87, 95% CI 2.18 to 17.9), being anaemic (AOR: 12.45, 95% CI 5.6 to 41.01), depression (AOR: 4.51, 95% CI 1.91 to 11.20), mild weight loss (AOR: 4.2 95% CI 2.56 to 13.9) and moderate weight loss (AOR: 5.1, 95% CI 1.85 to 16.12), respectively. CONCLUSION The findings of this study revealed that experiencing fatigue is quite common among adult people living with HIV. It is important for the healthcare professionals and people living with HIV to understand; the possible causes of fatigue, remedies and ways to reclaim energy. The predisposing factors and complications that cause fatigue should be aggressively diagnosed and treated by the clinicians. Further qualitative studies exploring the reasons for experiencing HIV-related fatigue might help designing interventions.
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Affiliation(s)
- Moges Baye
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, and Specialized Hospital, Gondar, Amhara, Ethiopia
| | - Berihu Fisseha
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mulugeta Bayisa
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, and Specialized Hospital, Gondar, Amhara, Ethiopia
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Solomon Mekonnen Abebe
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Balamurugan Janakiraman
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Tigray, Ethiopia
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24
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Xiao X, Reynolds NR, Saligan L, Lei Y, Wang M, Wang H. Effectiveness of non-pharmacological interventions to decrease fatigue in people living with HIV/AIDS: a protocol of systematic review and meta-analysis. BMJ Open 2020; 10:e040996. [PMID: 32963072 PMCID: PMC7509953 DOI: 10.1136/bmjopen-2020-040996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Fatigue is a common symptom among people living with HIV (PLWH). It has a substantial adverse impact on functional status and the ability to conduct activities of daily living. Identifying effective strategies to prevent or reduce fatigue is significant to promote the quality of life of this vulnerable population. The purpose of this review is to synthesise the non-pharmacological evidence and assess the effects of interventions on reducing HIV-related fatigue among PLWH. METHODS AND ANALYSIS We will comprehensively search literature available up to 30 June 2020, in the following databases: PubMed, Embase, CINAHL, Cochrane Library, Web of Science and PsycINFO. The reference list of selected studies and relevant published reviews will also be screened to retrieve potential articles. Two reviewers will identify the eligible articles, extract data and identify the biases in the selected studies. Any disagreements will be referred to a third reviewer. We will qualitatively synthesise the evidence and pool data with meta-analysis according to the heterogeneity of different studies. ETHICS AND DISSEMINATION This systematic review will not raise any ethical issues since it is a secondary data collection and analysis. The results will inform effective strategies to reduce fatigue among PLWH. The final report will be published in a peer-reviewed journal and academic conferences. PROSPERO REGISTRATION NUMBER CRD42020153715.
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Affiliation(s)
- Xueling Xiao
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy R Reynolds
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leorey Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Yunxiao Lei
- School of Nursing, Henan University of Science and Technology, Luoyang, Henan, China
| | - Min Wang
- HIV/AIDS Department, First Hospital of Changsha, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
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25
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McElhiney MC, Rabkin JG, Daughters SB, Timperlake EC, Wainberg ML. Returning to work after fatigue treatment and counseling in HIV/AIDS. Work 2020; 64:843-852. [PMID: 31815724 DOI: 10.3233/wor-193046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Employment rates for people with HIV/AIDS are low, compared to the general population. One widespread barrier is fatigue, accompanied by daytime sleepiness and a lack of stamina. Previous pharmacological studies have demonstrated improvement of fatigue-related symptoms without affecting work-related goal attainmentOBJECTIVE:In this pilot study, we sought to determine whether a pharmacologic-behavioral two-phase combined approach could facilitate returning to work. METHODS HIV+ participants with fatigue were treated with armodafinil. If energy improved, 8 sessions of biweekly manualized Behavioral Activation (BA) counseling were added to medication maintenance. Outcome was assessed on a 3-point scale along with clinician and self-ratings. RESULTS Of the 46 participants enrolled in BA, 15 (33%) did not complete all 8 sessions: 6 got jobs so they no longer needed counseling; 4 did not like BA, and 5 dropped out for reasons such as moving away or substance use relapse. Of the 46, 29 (63%) attained their vocational goal and showed significant changes on self-report scales. CONCLUSIONS Our integrated treatment including armodafinil plus BA counseling significantly increased the success of achieving work-related goals. The two-phase medication plus counseling program was well-tolerated by participants and the manualized BA counseling was readily applied by counselors without advanced mental health training, making the method potentially feasible in community settings.
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Affiliation(s)
- Martin C McElhiney
- Department of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Judith G Rabkin
- Department of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Milton L Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.,Department of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
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26
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Dobra A, Buhikire K, Voss JG. Identifying mediating variables with graphical models: an application to the study of causal pathways in people living with HIV. J Appl Stat 2020; 47:1298-1314. [DOI: 10.1080/02664763.2019.1669543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adrian Dobra
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Katherine Buhikire
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joachim G. Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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27
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Gebreyesus T, Belay A, Berhe G, Haile G. Burden of fatigue among adults living with HIV/AIDS attending antiretroviral therapy in Ethiopia. BMC Infect Dis 2020; 20:280. [PMID: 32295546 PMCID: PMC7161178 DOI: 10.1186/s12879-020-05008-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fatigue is one of the most common and devastating Human Immuno-deficiency Virus (HIV) - related symptoms, with a varying prevalence in different study areas. In Ethiopia, there is a paucity of information on the magnitude and factors associated with fatigue among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients. This may lead to under-diagnosis and eventually under-management of the symptom. METHODS Institution based cross-sectional study design was conducted among 609 HIV/AIDS patients who were selected by using a systematic random sampling method. Data were collected by using interviewer administered structured questionnaire. Level of fatigue was measured by Fatigue Severity Scale. RESULTS The prevalence of fatigue was found to be 51.7%. The factors associated with fatigue were: Parity [AOR = 2.01; 95% CI: 1.09-3.71], CD4 count 200-499 cells/mm3 [AOR = 2.81; 95% CI: 1.58-4.99], anemia [AOR = 4.90 95% CI: 2.40-9.97], co-morbidities [AOR = 3.65; 95% CI: 1.71-7.78], depression [AOR = 3.68 95% CI: 1.99-6.79], not being physically active [AOR = 3.20 95% CI: 1.50-6.81], clinical stage II or IV HIV [AOR = 3.11; 95% CI: 1.51-6.40] and [AOR = 4.08; 95% CI: 1.37-12.14], respectively. CONCLUSION The finding of this study revealed that fatigue is a common health problem among adult People Living with HIV (PLHIV). Factors associated with fatigue included: Parity, CD4 count 200-499 cells/mm3, Clinical Stage II or IV HIV, anemia, co-morbidities, depression, and not being physically active. The health care service needs to address the predisposing factors by provision integrated care including timely detection and treatment of comorbidities, mental health problems, and promote physical activity to slow down disease progression and then reduce exposure to fatigue.
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Affiliation(s)
- Tsiwaye Gebreyesus
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, P.O.Box: 1871, Mekelle, Ethiopia
| | - Addisalem Belay
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, P.O.Box: 1871, Mekelle, Ethiopia
| | - Gebretsadik Berhe
- Department of Epidemiology, School of Public Health, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Gebremedhin Haile
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, P.O.Box: 1871, Mekelle, Ethiopia
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28
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Pujasari H, Levy J, Culbert G, Steffen A, Carley D, Kapella M. Sleep disturbance, associated symptoms, and quality of life in adults living with HIV in Jakarta, Indonesia. AIDS Care 2020; 33:39-46. [PMID: 32266830 DOI: 10.1080/09540121.2020.1748868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Adverse symptom experiences, including sleep disturbances, are important negative predictors of quality of life (QoL), but few studies conducted in low-income countries have examined the impact of poor sleep and its associated symptoms on QoL among people living with HIV (PLWH). To this end, 200 PLWH who were receiving treatment with antiretroviral therapy (ART) were recruited through a community nongovernment organization in Jakarta, Indonesia. Validated instruments measured QoL, sleep disturbance, fatigue, pain, ART adherence, substance use, drug use severity, and methadone treatment. Descriptive statistics, bivariate correlations, and multivariate linear regression were conducted to identify independent correlates of QoL. Overall, participants perceived their QoL as being good to very good (mean = 105.70, standard deviation = 14.7) and higher among women than men (p < 0.05). After adjusting for sex, education, drug-use severity, and ART adherence, QoL was negatively associated with fatigue, insomnia, and pharmacological treatment with methadone. Along with other known symptoms of HIV, sleep problems and their complications are important to clinically address and research more fully to assure satisfying QoL among PLWH.
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Affiliation(s)
- Hening Pujasari
- Faculty of Nursing, Universitas Indonesia, Depok, Jawa Barat, Indonesia
| | - Judith Levy
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Gabriel Culbert
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alana Steffen
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - David Carley
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Mary Kapella
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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29
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Balthazar M, Diallo I, Pak VM. Metabolomics of sleep disorders in HIV: a narrative review. Sleep Breath 2020; 24:1333-1337. [PMID: 32198720 DOI: 10.1007/s11325-019-01993-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Sleep disturbances are prevalent among patients with human immunodeficiency virus (HIV), even those who are being treated on antiretroviral therapy. It is important to understand the metabolomic mechanisms underlying sleep disturbances among people living with HIV (PLWH). METHODS A review of recent literature was performed to explore the use of metabolomics in understanding sleep among PLWH. RESULTS We found only two studies that used metabolomics to explore sleep health among PLWH. CONCLUSION This paper reviews common sleep disorders in HIV, the existing metabolomic studies that may explain the relationship, and implications for future research. The use of metabolomics in exploring sleep disorders among PLWH will help to elucidate mechanistic links to improve patient outcomes.
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Affiliation(s)
- Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, USA
| | - Idiatou Diallo
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Victoria M Pak
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, USA.
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30
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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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31
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Barroso J, Madisetti M, Mueller M. A Feasibility Study to Develop and Test a Cognitive Behavioral Stress Management Mobile Health Application for HIV-Related Fatigue. J Pain Symptom Manage 2020; 59:242-253. [PMID: 31539601 PMCID: PMC6989380 DOI: 10.1016/j.jpainsymman.2019.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022]
Abstract
CONTEXT Exacerbated by life stressors, fatigue is the most common symptom for people living with HIV. OBJECTIVE To adapt, develop, and assess the feasibility of a Cognitive Behavioral Stress Management Mobile Health (CBSM mHealth) application (app) for HIV-related fatigue. METHODS This study had two phases: app development with key informants (N = 5) and a randomized controlled trial (N = 30). Patients randomized to the intervention group completed 10 weekly CBSM modules; those in the control group received a generic healthy lifestyle app. Measures included HIV-related fatigue, depression, anxiety, stressful life events, CD4 count, HIV viral load, credibility and acceptability of the intervention, and barriers to treatment participation. RESULTS We were able to recruit participants for this study, and they were able to complete the required measures. They found the intervention to be credible and acceptable and reported few barriers to treatment participation. The direction of change in the primary outcome, a decrease in fatigue, is in the expected direction and provides evidence of the promise of the intervention, which still needs to be tested in an adequately powered trial. For completers (randomized to the intervention group and completed at least 80% of the modules), there were significant changes (95% CI; lower scores indicate improvement) in fatigue intensity (from 64.2 to 59.7) and overall fatigue-related functioning (from 6.6 to 4.2). CONCLUSION We have proof of concept as to the feasibility, acceptability, and initial signals of efficacy for an mHealth intervention to help people with HIV-related fatigue better cope with stress and reduce their fatigue.
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Affiliation(s)
- Julie Barroso
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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32
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Makic MB, Gilbert D, Jankowski C, Reeder B, Al-Salmi N, Starr W, Cook PF. Sensor and Survey Measures Associated With Daily Fatigue in HIV: Findings From a Mixed-Method Study. J Assoc Nurses AIDS Care 2020; 31:12-24. [PMID: 31860594 PMCID: PMC8626233 DOI: 10.1097/jnc.0000000000000152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fatigue is the most common symptom among people living with HIV (PLWH), but may have many causes. This mixed-method study was designed to characterize PLWH's fatigue experiences and associated self-management behaviors, using Two Minds Theory. Fifty-five PLWH completed daily smartphone surveys on psychological states and fatigue at random times for 30 days and used a Fitbit Alta™ wristband. Within-person multilevel models were used to identify univariate correlates of fatigue. The first 25 participants also completed qualitative interviews about their experiences, and results were compared across methods. Participants had significant fatigue despite well-controlled HIV. Fatigue varied between persons and over time. Fatigue was associated with physical activity, sleep, daily psychological states, and barriers to self-care. PLWH reported new insights into fatigue from self-monitoring. There are potential opportunities for PLWH to improve sleep, activity, or stress management to alleviate fatigue. PLWH were interested in reducing fatigue and willing to use self-monitoring technology.
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Affiliation(s)
- Mary Beth Makic
- University of Colorado College of Nursing, Aurora, Colorado, USA
| | - Danielle Gilbert
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Blaine Reeder
- University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
| | - Nasser Al-Salmi
- University of Colorado College of Nursing, Aurora, Colorado, USA
| | - Whitney Starr
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Paul F. Cook
- University of Colorado College of Nursing, Aurora, Colorado, USA
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33
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The Symptoms Self-Management Center (SSMC): Methods for developing and implementing technology-enhanced self-management interventions for pain and fatigue. Appl Nurs Res 2019; 50:151194. [PMID: 31676300 DOI: 10.1016/j.apnr.2019.151194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/28/2019] [Indexed: 11/21/2022]
Abstract
The National Institutes of Nursing Research provides funding via the P20 grant mechanism for research infrastructure and resources to develop nurse scientists with expertise in symptom self-management. The Medical University of South Carolina College of Nursing was awarded a P20 grant in 2016 to build the Symptoms Self-Management Center for technology-enhanced interventions to address pain and fatigue in individuals with chronic health conditions. Resources were derived from three key subcores: bioinformatics, mHealth and eHealth consultative services, and community engagement. This paper describes methods for deriving specific resources within each subcore, the application of subcore resources in two pilot studies, and lessons learned during the early phases of our Symptoms Self-Management Center implementation.
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Patient-Reported Outcomes in First-Line Antiretroviral Therapy: Results From NEAT001/ANRS143 Trial Comparing Darunavir/Ritonavir in Combination With Tenofovir/Emtricitabine or Raltegravir. J Acquir Immune Defic Syndr 2019; 79:519-526. [PMID: 30234665 DOI: 10.1097/qai.0000000000001844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are few data comparing patient-reported outcomes (PROs) in randomized trials of initial antiretroviral therapy. We present results from a substudy of the NEAT001/ANRS143 trial. METHODS The randomized trial compared first-line DRV/r 800/100 mg once daily plus RAL 400 mg twice daily and DRV/r plus TDF/FTC 245/200 mg once daily. Changes in PROs were assessed with 3 questionnaires: EuroQoL 5 domains (EQ-5D), Center for Epidemiologic Studies Depression (CES-D) scale, and HIV Treatment Satisfaction Questionnaire. Major depressive disorder (MDD) was defined as CES-D ≥ 16. General estimating equations were used to model change over 96 weeks in PROs from baseline. RESULTS Of the 805 participants, 797 (99%) contributed to the substudy. Baseline PRO data were similar for the 2 randomized groups. Health status improved over time with a mean increase in EQ-5D visual analogue scale (VAS) of 8.0 by W96 [95% confidence interval (CI): 6.5 to 9.4; P < 0.001], and no statistically significant differences between groups (difference of 0.3 on VAS score (95% CI: -1.7 to 2.3); P = 0.7, global P value ≥0.05 for all domains over follow-up). There was no significant difference between groups on CES-D [difference of -0.1 (95% CI: -1.3 to 1.1); P = 0.9], or MDD during follow-up, adjusted for baseline MDD (odds ratio = 0.98, 95% CI: 0.82 to 1.18; P = 0.9). RAL + DRV/r group had lower level of convenience (P = 0.03) and fitted less well into patients' lifestyle (P = 0.007) than the TDF/FTC + DRV/r regimen, and was associated with lower treatment satisfaction [median score: 53 RAL + DRV/r vs 55 TDF/FTC + DRV/r (P = 0.001)]. CONCLUSION PROs improved after starting antiretroviral therapy, with no statistically significant difference between groups. The lower satisfaction with RAL + DRV/r may be explained by twice-daily administration.
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Nosrat S, Whitworth JW, SantaBarbara NJ, Dunsiger SI, Ciccolo JT. Acute Effects of Resistance-Exercise Intensity in Depressed Black/African Americans Living With HIV: A Randomized Pilot Study. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2019; 41:261-270. [PMID: 31387082 DOI: 10.1123/jsep.2018-0301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Depressive symptoms and fatigue are prevalent among people living with human immunodeficiency virus. Resistance exercise is known to stimulate a positive affective response. OBJECTIVE To examine the acute psychological effects of resistance-exercise intensity among Black/African-American people living with human immunodeficiency virus and experiencing depressive symptoms. METHODS A total of 42 participants were randomized into a moderate- (n = 21) or high-intensity (n = 21) group. Assessments were collected before exercise (PRE), at the midpoint (MID), immediately following (POST) exercise, and 15 (DELAY 15) and 30 (DELAY 30) min after. RESULTS In the moderate-intensity group, affect improved PRE to POST, PRE to DELAY 15 and DELAY 30, and perceived distress decreased from PRE to all time points. In the high-intensity group, affect declined PRE to MID, and perceived distress decreased PRE to DELAY 15 and DELAY 30. Perceived activation increased PRE to MID, and POST in both groups (ps < .01). CONCLUSIONS The moderate-intensity group compared with the high-intensity group is more effective at improving affect and energy and at reducing distress.
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Affiliation(s)
| | - James W Whitworth
- Teachers College Columbia University
- Boston University School of Medicine
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Filippi M, Preziosa P, Rocca MA. Brain mapping in multiple sclerosis: Lessons learned about the human brain. Neuroimage 2019; 190:32-45. [DOI: 10.1016/j.neuroimage.2017.09.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 02/07/2023] Open
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Bergamaschi A, d'Arripe-Longueville F, Gray LL, Colson SS, Goujard C, Ferez S, Rouanet I, Durant J, Rosenthal E, Pradier C, Duracinsky M, Schuft L. Perceived HIV-related physical fatigue, sociodemographic characteristics and physical activity: A cross-sectional study. J Clin Nurs 2019; 28:2147-2156. [PMID: 30667107 DOI: 10.1111/jocn.14793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To get a deeper understanding of correlates of perceived HIV-related fatigue by exploring its associations with sociodemographic characteristics and physical activity level of HIV-infected people. BACKGROUND Previous studies on HIV-related fatigue have mainly focused on physiological and psychological characteristics, but few have considered its associations with sociodemographic variables. In addition, while physical activity has been found to reduce acute fatigue among HIV-infected people, its links with chronic HIV-related fatigue remain to be explored. DESIGN The study employed an observational and cross-sectional survey design. The manuscript was organised according to STROBE guidelines. METHOD A total of 560 people living with HIV in France completed a measure of perceived physical fatigue using the Fatigue Intensity Scale. The predictors targeted sociodemographic characteristics and two measures of individuals' reported level of physical activity. Data were analysed by a stepwise multiple regression model. RESULTS The results showed that lower age, higher physical activity level and socio-economic status were significantly associated with reduced perceived physical fatigue, explaining 25% of the variance. CONCLUSIONS The results highlighted the importance of considering sociodemographic and lifestyle characteristics to better characterise HIV-related fatigue, in particular in an era where HIV as a chronic illness challenges questions of quality of life throughout increasingly longer lifespans. RELEVANCE TO CLINICAL PRACTICE The results of this study have implications for HIV care professionals in terms of improving strategies for managing chronic fatigue or promoting physical activity according to more specific profiles of HIV-infected people.
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Affiliation(s)
| | | | | | | | - Cecile Goujard
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France
| | - Sylvain Ferez
- Laboratory Health, Education, Handicap Situations (EA 4614 SANTESIH), University of Montpellier, Montpellier, France
| | - Isabelle Rouanet
- Department of Infectious Diseases, Hospital of Nîmes, Nîmes, France
| | - Jacques Durant
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Eric Rosenthal
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Christian Pradier
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Public Health, Université Côte d'Azur, CHU, Nice, France
| | - Martin Duracinsky
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France.,Patient-Centered Outcomes Research (EA 7334 REMES), University of Paris-Diderot, Paris, France
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Coetzee BJ, Loades ME, Du Toit S, Kagee A. Correlates of Fatigue Among South African Adolescents Living with HIV and Receiving Antiretroviral Therapy. AIDS Behav 2019; 23:602-608. [PMID: 30659425 PMCID: PMC6754751 DOI: 10.1007/s10461-018-02384-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fatigue among adolescents living with HIV is poorly understood. In this study, we examined the relationships between fatigue and demographic and psychosocial variables to further the understanding of the symptom experience and associated factors. We recruited consecutive attenders at ART clinics in the Western Cape, South Africa (N = 134, age 11-18 years). Participants completed a battery of questionnaires including measures of fatigue, insomnia and mood disturbance. Just under a quarter (24.6%) of adolescents reported elevated levels of fatigue that affected their functioning. The linear combination of age, depression, and insomnia explained 40.6% of the variance in fatigue. Amongst adolescents with HIV, fatigue seems a problematic symptom associated with poor sleep and mood disturbance. Timely identification and management of these potentially disabling symptoms are needed to attain better health outcomes and retention in care in this group. Interventions aimed at ameliorating these symptoms are needed.
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Affiliation(s)
- Bronwynè J Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
| | | | - Stefani Du Toit
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Martin K, Naclerio F, Karsten B, Vera JH. Physical activity and quality of life in people living with HIV. AIDS Care 2019; 31:589-598. [PMID: 30712360 DOI: 10.1080/09540121.2019.1576848] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As life expectancy in people living with HIV (PWH) has increased, the focus of management has shifted to preventing and treating chronic illnesses. Regular physical activity (PA) has been shown to reduce the impact of HIV on both physical and mental health. Our objectives were to assess the PA levels of PWH compared to HIV negative controls; investigate factors associated with PA; and determine the effect of PA levels on quality of life and mental well-being. We recruited 110 PWH and 110 HIV negative controls in this cross-sectional, single-centre study. Physical activity, quality of life and mental well-being were assessed using the rapid assessment of physical activity tool, EQ-5D-5L Questionnaire, and the Warwick-Edinburgh Mental Well-being Score. Binary logistic regression and multiple linear regression were used to identify factors associated with PA levels and mental well-being scores respectively. PWH were less likely to meet the WHO-recommended PA requirements compared to controls (50.0% vs. 64.5%; p = 0.041) and had significantly lower mental wellbeing and quality of life scores. Additionally, in PWH higher PA levels were associated with improved self-rated quality of life scores (p = 0.027). Our results suggest that targeted exercise programmes could have a beneficial effect on health status in PWH.
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Affiliation(s)
- Kevin Martin
- a Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | - Fernando Naclerio
- b Department of Life and Sports Sciences , University of Greenwich , London , UK
| | - Bettina Karsten
- d Department of Exercise and Sport Science , LUNEX International University of Health, Exercise and Sports , Differdingen , Luxembourg
| | - Jaime H Vera
- a Brighton and Sussex University Hospitals NHS Trust , Brighton , UK.,c Department of Global Health and Infection , Brighton and Sussex Medical School , Brighton , UK
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Comley-White N, Potterton J, Ntsiea V. The physical sequelae of perinatally acquired HIV in adolescents: a research proposal. BMC Res Notes 2019; 12:62. [PMID: 30691534 PMCID: PMC6350387 DOI: 10.1186/s13104-019-4079-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/11/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives As the global access of antiretrovirals for HIV-infected infants improves, so the body of perinatally HIV-infected adolescents (PHIVA) grows. The neurological and physical complications of HIV, both in children and in adults, are well established, however there is a paucity of data pertaining to PHIVA, a group of people who have had a lifetime exposure to the virus and to antiretrovirals. There has been a resounding call for further research in this area, as well as for the development of policies and programmes for this population. The aim of this study is to determine the physical sequelae in PHIVA and to propose a model of care for this population. Methods Through interviews with PHIVA, the perceived physical challenges will be established. Thereafter a cohort study with age-matched participants will determine if PHIVA have any limitations in fatigue, endurance, motor function and muscle strength, body mass index, peripheral neuropathy, level of disability and quality of life. Using these results, a model of care will be proposed through the nominal group technique with both PHIVA and clinicians working in HIV and adolescence.
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Affiliation(s)
- Nicolette Comley-White
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa.
| | - Joanne Potterton
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa
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Hulme K, Safari R, Thomas S, Mercer T, White C, Van der Linden M, Moss-Morris R. Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews. PLoS One 2018; 13:e0203367. [PMID: 30312325 PMCID: PMC6193578 DOI: 10.1371/journal.pone.0203367] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions. METHODS Scoping review methodological frameworks were used. Electronic bibliographic databases were searched (inception to November 2016) for systematic reviews of fatigue interventions in long term conditions. Inclusion criteria were: long term physical health condition; review focus on fatigue management; objective and systematic review process; primary review outcome is fatigue. Articles focussing on surgical interventions or treatments thought to trigger fatigue were excluded. A narrative synthesis was performed. RESULTS Of 115 full texts screened, 52 reviews were included. Interventions were categorised as pharmacological and non-pharmacological (exercise, psychological/behavioural and complementary medicine). Pharmacological interventions did not consistently demonstrate benefit, except for anti-TNFs and methylphenidate which may be effective at reducing fatigue. Non-pharmacological interventions such as graded exercise and fatigue-specific psychological interventions may be effective, but heterogeneous intervention components limit conclusions. 'Complementary medicine' interventions (e.g. Chinese herbal medicines) showed promise, but the possibility of publication bias must be considered. CONCLUSIONS Further research is necessary to inform clinical practice. The reported effectiveness of some interventions across inflammatory health conditions, such as anti-TNFs, aerobic exercise, and psychologically based approaches such as CBT, highlights a potential transdiagnostic avenue for fatigue management. More novel strategies that may be worth exploring include expressive writing and mindfulness, although the mechanisms for these in relation to fatigue are unclear. More work is needed to identify transdiagnostic mechanisms of fatigue and to design interventions based on these.
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Affiliation(s)
- Katrin Hulme
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Health Psychology Department, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Sarah Thomas
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom
| | - Claire White
- Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Marietta Van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Wang K, Lin H, Li L, Wu Q, Shen W, Liu X, Gao M, Zhou S, Ding Y, He N. Low body mass index and efavirenz use are independently associated with self-reported fatigue in HIV-infected patients. AIDS Care 2018; 31:513-518. [PMID: 30246544 DOI: 10.1080/09540121.2018.1524110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This retrospective cohort study was conducted from January 2009 to July 2016 to explore the occurrence and risk factors of self-reported fatigue within the first 6 months after receiving antiretroviral treatment (ART) among patients living with HIV in Taizhou City of Zhejiang province, Eastern China. In total, 1163 HIV-infected patients with a median follow-up duration of 27.8 months were included in the analysis. Among them, 261 (22.4%) reported fatigue within the first 6 months after ART. In the multivariable logistic regression analysis, self-reported fatigue within the first 6 months after ART was negatively associated with junior middle-school education or above, baseline CD4 cell count of 200-349 and >350 cells/μL (vs < 200 cells/μL), overweight at baseline (vs normal weight) but positively associated with ≥50 years old at initiation of ART (vs <30 years old), underweight at baseline, use of efavirenz (EFV) in the first-line regimen. Our data suggest that earlier initiation of ART and higher body mass index are preferred to restore the energy of HIV-infected patients with the EFV use in the era of ART in China.
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Affiliation(s)
- Keran Wang
- a Department of Epidemiology, School of Public Health , Fudan University , Shanghai , People's Republic of China.,b Key Laboratory of Public Health Safety of Ministry of Education , Shanghai , People's Republic of China.,c Collaborative Innovation Center of Social Risks Governance in Health , Fudan University , Shanghai , People's Republic of China
| | - Haijiang Lin
- d Taizhou City Center for Disease Control and Prevention , Taizhou City of Zhejiang Province , People's Republic of China
| | - Lingling Li
- a Department of Epidemiology, School of Public Health , Fudan University , Shanghai , People's Republic of China.,b Key Laboratory of Public Health Safety of Ministry of Education , Shanghai , People's Republic of China.,c Collaborative Innovation Center of Social Risks Governance in Health , Fudan University , Shanghai , People's Republic of China
| | - Qionghai Wu
- d Taizhou City Center for Disease Control and Prevention , Taizhou City of Zhejiang Province , People's Republic of China
| | - Weiwei Shen
- d Taizhou City Center for Disease Control and Prevention , Taizhou City of Zhejiang Province , People's Republic of China
| | - Xing Liu
- a Department of Epidemiology, School of Public Health , Fudan University , Shanghai , People's Republic of China.,b Key Laboratory of Public Health Safety of Ministry of Education , Shanghai , People's Republic of China
| | - Meiyang Gao
- a Department of Epidemiology, School of Public Health , Fudan University , Shanghai , People's Republic of China.,b Key Laboratory of Public Health Safety of Ministry of Education , Shanghai , People's Republic of China
| | - Sujuan Zhou
- a Department of Epidemiology, School of Public Health , Fudan University , Shanghai , People's Republic of China.,b Key Laboratory of Public Health Safety of Ministry of Education , Shanghai , People's Republic of China
| | - Yingying Ding
- a Department of Epidemiology, School of Public Health , Fudan University , Shanghai , People's Republic of China.,b Key Laboratory of Public Health Safety of Ministry of Education , Shanghai , People's Republic of China
| | - Na He
- a Department of Epidemiology, School of Public Health , Fudan University , Shanghai , People's Republic of China.,b Key Laboratory of Public Health Safety of Ministry of Education , Shanghai , People's Republic of China.,c Collaborative Innovation Center of Social Risks Governance in Health , Fudan University , Shanghai , People's Republic of China
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Gray L, Chalabaev A, Durant J, Rosenthal E, Pradier C, Duracinsky M, Rouanet I, Schuft L, Colson SS, d'Arripe-Longueville F. Exercise stereotypes and fatigue in people living with HIV: does self-efficacy play a mediating or a moderating role? ACTA ACUST UNITED AC 2018; 76:23. [PMID: 29719721 PMCID: PMC5925845 DOI: 10.1186/s13690-018-0269-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022]
Abstract
Background Recent research suggests that exercise stereotypes may influence physical activity through ego depletion and internalization mechanisms. The objective of this study was to better understand exercise stereotypes mechanisms among people living with HIV (PLHIV) by further examining the role of exercise self-efficacy and perceived physical fatigue in the relationship between exercise stereotypes and physical activity. Methods Three hundred five people living with HIV were recruited to provide data on their stereotypes related to exercise, exercise self-efficacy, perceived physical fatigue as well as their level of physical activity (PA). Results From the different models tested, the serial mediation model with exercise self-efficacy and perceived physical fatigue as mediators of the relationship between exercise stereotypes and PA, as well as the moderated mediation model with exercise selfefficacy as a moderator of exercise stereotypes and perceived physical fatigue a mediator, provided good fits to the data. However, the moderated mediation model (with indirect associations between negative exercise stereotypes and PA via perceived physical fatigue being moderated by exercise self-efficacy) explained the most variance in PA (R2 = .27). Conclusion The moderated mediation model suggests that exercise stereotypes might influence PA through ego depletion mechanisms and be tempered by exercise self-efficacy.
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Affiliation(s)
- Laura Gray
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
| | | | - Jacques Durant
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Archet 1, France
| | - Eric Rosenthal
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Archet 1, France
| | - Christian Pradier
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France.,Department of Public Health, Université Côte d'Azur, CHU, Archet 1, France
| | - Martin Duracinsky
- AP-HP Department of Clinical Research Bicêtre Hospital, (Le Kremlin Bicêtre), France
| | - Isabelle Rouanet
- Department of Infectious Diseases Nîmes Hospital, (Nîmes), France
| | - Laura Schuft
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
| | - Serge S Colson
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
| | - Fabienne d'Arripe-Longueville
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
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Verbooy K, Wagener M, Kaddouri M, Roelofs P, Miedema H, van Gorp E, Brouwer W, van Exel J. Are people living with HIV less productive at work? AIDS Care 2018. [PMID: 29517931 DOI: 10.1080/09540121.2018.1447076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Health problems may cause decreased productivity among working people. It is unclear if this also applies for people living with HIV (PLWH). This cross-sectional study compares data of PLWH of one of the main HIV treatment centres in the Netherlands (n = 298) to data of the general working population from a previously conducted study (n = 986). We investigate whether productivity at work differs between these groups. The questionnaires used in these studies contained a core of identical questions regarding productivity losses, in the form of absenteeism and presenteeism, over a four-week period and a variety of baseline characteristics, including health status measured with EQ-5D. For PLWH additional clinical data were collected from patient records. From the data, descriptive statistics were computed to characterize the samples. Pearson correlations were used to explore significant associations of productivity with baseline characteristics. A two-part model was used to evaluate both the occurrence and of size of productivity losses in working PLWH and an aggregated sample of PLWH and the general population. It was observed that, on average, total productivity losses do not differ significantly between working PWLH and the general working population, but that the occurrence and size of absenteeism and presenteeism were different. Furthermore, more health problems were associated with higher productivity losses. HIV status was not significantly associated with productivity losses. We conclude that among working people, health status was related to productivity losses but HIV status was not. However, further research is needed into the relation between HIV status and unemployment.
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Affiliation(s)
- Kaya Verbooy
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Marlies Wagener
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands.,c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Meriam Kaddouri
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Pepijn Roelofs
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Harald Miedema
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Eric van Gorp
- c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands.,d Department of Internal Medicine , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Werner Brouwer
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Job van Exel
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands.,e Erasmus School of Economics , Erasmus University Rotterdam , Rotterdam , the Netherlands
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Wagener MN, van den Dries L, Van Exel J, Miedema HS, van Gorp ECM, Roelofs PDDM. Determinants of Employment in People Living with HIV in the Netherlands. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:45-56. [PMID: 28160181 DOI: 10.1007/s10926-016-9692-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectives Since HIV has become a manageable chronic disease, employment is of increasing importance for people living with HIV (PLWH). This study aimed to investigate the level of work participation among PLWH in the Netherlands, and the associated determinants of employment. Methods For this study the baseline measurements of a longitudinal cohort study with a 2-year follow-up, the TREVI project, were used. The TREVI project aims to study cognitive function disorders among PLWH in relation to their employment, productivity, and social functioning. From December 2012 until December 2013, data on cognitive functioning, measured by the HIV Dementia Scale, and medical data derived from patient records were collected. Employment status and possible determinants of employment were assessed by a digital survey. Chi square analysis and multivariate logistic regression analysis were conducted in order to investigate the level of employment and associated determinants of employment. Results This cross-sectional study revealed significant differences in the level of employment compared with Dutch reference data: i.e. in the age group 40-54 years PLWH had a significantly lower employment rate than the general Dutch population. Multivariate analysis showed that employment was negatively associated with a lower or higher age (reference: 40-54 years), a longer period since diagnosis, problems with physical functioning, and a higher score on the HADS Depression. Having paid work at diagnosis was positively associated with employment. Conclusion PLWH, particularly in the age of 40-54, in the Netherlands have a significant lower level of employment compared to the general population. Counseling should address reduced psychological and physical functioning in order to improve the position of PLWH on the labor market.
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Affiliation(s)
- Marlies N Wagener
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
- Department of Viroscience, University Medical Centre Rotterdam, Erasmus MC, Rotterdam, The Netherlands.
| | - Lennert van den Dries
- Department of Viroscience, University Medical Centre Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Job Van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Harald S Miedema
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, University Medical Centre Rotterdam, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, University Medical Centre Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Pepijn D D M Roelofs
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Spire B, Nait-Ighil L, Pugliese P, Poizot-Martin I, Jullien V, Marcelin AG, Billaud E. Quality of life improvement in HIV-1 patients treated with raltegravir in a real-life observational study: RACING. HIV CLINICAL TRIALS 2017; 18:1-16. [PMID: 28125951 DOI: 10.1080/15284336.2016.1251030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Good efficacy and safety of raltegravir in person living with HIV was demonstrated in clinical trials over five years, but real-life data, particularly about quality of life (QoL), are lacking. QoL was evaluated over time in adult patients first treated or switched to regimens containing raltegravir in an observational cohort study. METHODS Patient QoL was evaluated using the Fatigue Impact Scale (FIS) and the HIV Symptom Index (HSI). Data were collected at baseline and at 1, 3, 6, 12, 18, and 24 months. Baseline FIS and HSI subscores were compared with the scores at each visit using the paired Wilcoxon test. The impact of time, sociodemographic and medical variables upon patient-perceived fatigue and symptoms was also assessed using mixed multivariate models. RESULTS From baseline, all FIS and HSI subscores improved significantly after one month of treatment. In addition, psychosocial FIS subscores and both the frequency of bothersome symptoms and HSI subscores improved significantly at each visit. Physical FIS subscores also improved significantly, except at month 18, whereas both cognitive and total FIS subscores improved only after 6 months and 24 months, respectively. In multivariate analysis, employment was independently associated over time with improved improvement in both FIS and HSI subscores. CONCLUSION Patient QoL improved significantly over a 24-month period of treatment with a raltegravir-containing regimen. FIS and HSI are sensitive tools to measure the impact of new antiretroviral combinations on a patient's perception of QoL.
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Affiliation(s)
- Bruno Spire
- a INSERM UMR912 Aix-Marseille University , Marseille , France
| | | | - Pascal Pugliese
- c Department of Infectious Diseases , L'Archet Hospital , Nice , France
| | | | - Vincent Jullien
- e Clinic Pharmacology Department , Cochin Hospital , Paris , France
| | | | - Eric Billaud
- g Department of Infectious Diseases , Hotel Dieu Hospital , Nantes , France
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Loades ME, Kagee A. Exploring our understanding of fatigue among adolescents living with HIV: Highlighting the unknown. J Health Psychol 2017; 24:125-136. [PMID: 28810460 DOI: 10.1177/1359105317710320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Due to antiretroviral therapies, HIV is now a chronic illness rather than a terminal disease. Chronic symptoms, including fatigue, should be identified and managed to prevent or minimise their potential negative consequences. We apply a Symptom Management Model to conceptualise fatigue among adolescents with HIV. In the context of minimal research, we seek to identify a research agenda for resource-constrained contexts, where HIV prevalence remains high and treatment adherence is a significant problem. By better understanding and addressing the symptom of fatigue, treatment adherence, occupational, social and emotional functioning could be improved. We highlight conceptual, methodological and measurement-related caveats.
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Schuft L, Duval E, Thomas J, Ferez S. To be or not to be sick and tired: Managing the visibility of HIV and HIV-related fatigue. Health (London) 2017; 22:317-336. [PMID: 28401815 DOI: 10.1177/1363459317693406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article takes a new direction in exploring HIV-related fatigue by adopting a qualitative interactionist approach. We analyse the social meanings attributed to fatigue among people living with HIV in France, the social gains and losses of its visibility and the social frames that condition its discursive and physical expression. The two-part methodology combines grounded theory analysis of 50 transcribed unstructured interviews conducted across France and participant observations within four HIV-related associations. Results reveal that the visibility of fatigue is in part dependent on the visibility of this stigmatized illness. The expression of fatigue is therefore closely linked with disclosure and concerns about HIV stigma. The degree to which HIV and HIV-related fatigue are rendered (in)visible also depends on structural factors including gender prescriptions, as well as context effects such as the type of social or 'care' relations involved in the social frame of interaction.
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Affiliation(s)
| | | | - Julie Thomas
- Univ. Lyon, UJM-Saint-Etienne, Centre Max Weber, France
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Gibbons LE, Fredericksen R, Batey DS, Dant L, Edwards TC, Mayer KH, Mathews WC, Morales LS, Mugavero MJ, Yang FM, Paez E, Kitahata MM, Patrick DL, Crane HM, Crane PK. Validity assessment of the PROMIS fatigue domain among people living with HIV. AIDS Res Ther 2017; 14:21. [PMID: 28400850 PMCID: PMC5387298 DOI: 10.1186/s12981-017-0146-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/19/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate psychometric characteristics and cross-sectional and longitudinal validity of the 7-item PROMIS® Fatigue Short Form and additional fatigue items among people living with HIV (PLWH) in a nationally distributed network of clinics collecting patient reported data at the time of routine clinical care. Methods Cross-sectional and longitudinal fatigue data were collected from September 2012 through April 2013 across clinics participating in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We analyzed data regarding psychometric characteristics including simulated computerized adaptive testing and differential item functioning, and regarding associations with clinical characteristics. Results We analyzed data from 1597 PLWH. Fatigue was common in this cohort. Scores from the PROMIS® Fatigue Short Form and from the item bank had acceptable psychometric characteristics and strong evidence for validity, but neither performed better than shorter instruments already integrated in CNICS. Conclusions The PROMIS® Fatigue Item Bank is a valid approach to measuring fatigue in clinical care settings among PLWH, but in our analyses did not perform better than instruments associated with less respondent burden. Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0146-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanne Potterton
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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