Prevalence of mental distress and factors associated with symptoms of major depression among people living with HIV in Norway

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.

Factors associated with health-related quality of life in people living with HIV in Norway

BACKGROUND

Despite the advances in the treatment of HIV, people living with HIV (PLHIV) still experience impairment of health-related quality of life (HRQOL). The aim of the study was to explore factors associated with HRQOL in a well-treated Norwegian HIV population.

METHODS

Two hundred and forty-five patients were recruited from two outpatient clinics to participate in this cross-sectional study of addiction, mental distress, post-traumatic stress disorder, fatigue, somatic health, and HRQOL. The latter was measured using the 36-Item Short Form Health Survey (SF-36). Stepwise multiple linear regression analysis was used to examine the adjusted associations between demographic and disease-related variables and HRQOL.

RESULTS

The study population was virologically and immunologically stable. Their mean age was 43.8 (SD = 11.7) years, 131 (54%) were men, and 33% were native Norwegians. Compared with the general population (published in previous studies), patients reported worse SF-36 scores for five of eight domains: mental health, general health, social function, physical role limitation, and emotional role limitation (all p < 0.001). Compared with men, women reported better SF-36 scores within the domains vitality (63.1 (23.6) vs. 55.9 (26.7), p = 0.026) and general health (73.4 (23.2) vs. 64.4 (30.1), p = 0.009). In the multivariate analyses, higher SF-36- physical component score values were independently associated with young age (p = 0.020), being employed, student, or pensioner (p = 0.009), low comorbidity score (p = 0.015), low anxiety and depression score (p = 0.015), being at risk of drug abuse (p = 0.037), and not being fatigued (p < 0.001). Higher SF-36-mental component score values were independently associated with older age (p = 0.018), being from a country outside Europe or from Norway (p = 0.029), shorter time since diagnosis, low anxiety and depression score (p < 0.001), answering 'no' regarding alcohol abuse (p = 0.013), and not being fatigued (p < 0.001).

CONCLUSIONS

HRQOL was poorer in PLHIV than in the general population in Norway. It is important to focus on somatic and mental comorbidities when delivering health-care services in the ageing population of PLHIV to improve HRQOL even among a well-treated group of PLHIV as found in Norway.

Prevalence and predictors of fatigue among people living with HIV in Norway

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.

True User Involvement by People Living With HIV is Possible: Description of a User-driven HIV Clinic in Norway

The Greater Involvement of People Living with or Affected by HIV principle highlights the various contributions HIV-infected people can make in HIV program development and implementation. We present a unique example of how service users' involvement led to a complete organizational redesign of an outpatient HIV clinic in Southern Norway. We applied a user-driven, case study method, which showed that establishing a user board laid the foundation for the redesign process, as the board provided a clear infrastructure of user involvement and developed a set of user-defined targets for services. The main targets-optimal health, holistic care and treatment, and empowerment-were operationalized as a set of action points, such as establishing HIV nurse coordinators. While there is no single method for user involvement, we offer useful ideas that can help others develop an involvement project that is effective and sustainable.

[Short-term treatment of Hepatitis C in heroin-dependent patients]

BACKGROUND

Standardized treatment (24-week) with pegylated interferon and ribavirin induces sustained virological response in 80 % of patients with Hepatitis C (HCV) genotype 2 or 3. Most patients who are dependent on heroin and receiving methadone maintenance therapy (MMT) have been excluded from this treatment due to concerns about compliance. Short-term therapy (14 weeks) of other patient groups have shown promising results. The purpose of this study was to investigate the feasibility, efficacy and adverse effects of short-term treatment in a group of MMT patients with chronic hepatitis C infection genotype 3.

MATERIAL AND METHODS

Eight such patients were treated with weekly pegylated interferon injections (180 microg) and daily ribavirin tablets (800 mg) for 14 weeks. A nurse gave the injections and the patients were followed-up closely with weekly meetings, telephone and SMS.

RESULTS

Virus was eradicated in all patients after four weeks (RVR = 100 %). Seven patients completed treatment and all had undetectable virus at 14 weeks (88 %). At follow-up six months post treatment, six patients had sustained virus response (SVR = 75 %), the last patient refused to be tested. The adverse effects were of moderate intensity and could be treated with dose adjustments and supportive therapy, without additional medication. Drug abuse was a minor problem during treatment and no one relapsed to drug injections.

INTERPRETATION

Short-term (14 weeks) therapy with pegylated interferon and ribavirin can then be feasible, efficient and safe for Hepatitis C genotype 3. We stress the importance of close monitoring and support from a multidisciplinary team. MMT is a good opportunity to introduce HCV treatment.