Adrian Burgess

The reliability and validity of two HIV-specific health-related quality-of-life measures : a preliminary analysis

OBJECTIVEnTo evaluate the reliability and validity of two HIV-specific Quality-of-Life (QoL) questionnaires in a UK sample.nnnMETHODnSubjects were 99 HIV-seropositive gay men (23 were asymptomatic, 41 were asymptomatic, 35 had AIDS). QoL was measured using two HIV-specific QoL questionnaires.nnnMEASURESnAn adaptation of the Medical Outcomes Study questionnaire and a self-completion version of the Health-Related Quality-of-Life Questions. Affect was measured using the Hospital Anxiety and Depression (HAD) Scale. Disease measures included Centers for Disease Control and Prevention (CDC) stage, and CD4 and CD8 cell count.nnnRESULTSnBoth QoL instruments showed good internal reliability on all scales used. Many of the scales, particularly those related to physical health and functional performance, showed significant correlations with CD4 cell count and other measures of disease progression. Measures of physical health showed a deterioration in QoL as disease progressed from asymptomatic disease to AIDS. In contrast, most subscales purporting to measure psychological aspects of QoL did not correlate significantly with measures of disease progression, nor was there any difference between CDC stages. Subjects global ratings of QoL were most strongly correlated with the HAD depression scale, although there were also significant correlations with most other QoL scales.nnnCONCLUSIONnThis study provides further evidence for the reliability and validity of two HIV-specific QoL questionnaires in a wider range of disease stages than hitherto reported and raises issues relevant to the practical use of QoL scales in HIV disease.

The psychosocial impact of HIV infection in women.

The aim of the investigation was to study the prevalence of current and past psychiatric morbidity and psychosocial problems in HIV seropositive (HIV +ve) asymptomatic women. A cross-sectional controlled study including 57 HIV +ve women belonging to CDC group II and III (43 intravenous drug users and 14 non-IVDUs heterosexuals) and 23 HIV -ve women (15 intravenous drug users and 8 non-IVDUs heterosexuals) is reported. Outcome measures included, past psychiatric history, current psychological status (Zung Anxiety and Depression scales, Symptom Check List 90-Revised), Social Supports and Locus of Control Scales, and information on changes in work, social and sexual life after HIV testing. Results showed that HIV +ve women differed very little from HIV -ve controls regarding outcome measures and indeed for some variables HIV infected women had lower levels of psychological morbidity. Multiple regression analyses showed that alcohol misuse and a predominantly external locus of control accounted for the 29% of the variance of psychiatric distress (F = 9.23, p < 0.0006). The implications of the findings are discussed.

Prospective associations between lateralised brain function and immune status in HIV infection: Analysis of EEG, cognition and mood over 30 months

Prospective relations between individual differences in both lateralised neuro-psychophysiological functions and mood ratings with immune status (CD4 and CD8 counts) were examined in asymptomatic HIV-positive men (n = 27) over thirty months. They participated in a controlled study of zidovudine versus placebo (results published elsewhere). Measures included EEG spectra, neuropsychological tests and mood ratings. A model of reciprocal lateralised influences on the immune system was tested whereby patients with left superior to right hemispheric functions were predicted to show a less deleterious outcome than those with the opposite asymmetry pattern. Prospective relations with immune status were found in the EEG with lateralised theta, alpha and beta activity; among cognitive measures with word fluency, semantic processing, and lateralised motor and recognition memory (word/face) processes; with mood ratings including depression, confusion and the total mood score. The nature of the effects supported the laterality predictions. These unique data, showing that neuro-psychophysiological factors in HIV+ but otherwise healthy subjects predict immune competence and compromise present 2-3 years later, warrant replication in a larger cohort.

Heterosexuals and HIV disease: A controlled investigation into the psychosocial factors associated with psychiatric morbidity

The aim of the study was to evaluate the prevalence of current and past psychiatric morbidity among HIV seropositive and HIV seronegative heterosexual men and women and to identify the psychosocial factors associated with psychiatric morbidity. Twenty-four asymptomatic HIV seropositive and twenty-six HIV seronegative heterosexuals were included in the study. Outcome measures included socio-demographic data, psychiatric history, current psychological status (Zung Self-Report Anxiety Scale, Zung Self-Report Depression Scale, Symptom Check List 90-R), Social Supports and Locus of Control Scales, and information on changes in work, social, and sexual life after HIV testing. There were no significant differences between HIV seropositive heterosexuals and HIV seronegative controls on any of the outcome measures. Levels of psychiatric morbidity were generally low and similar to those expected in a general out-patient medical population. Multiple regression analyses showed that degree of social support was the only significant factor associated with psychiatric morbidity. The implications of the findings are discussed.

How should a positive HIV result be given? The patients' view

The study aimed at obtaining information about the experience of how the diagnosis of HIV infection was given. Thirty asymptomatic HIV seropositive subjects completed a self-report questionnaire enquiring about their views of the process of communication of a positive test result. Subjects current mood was assessed with the Hospital Anxiety and Depression Scale (HAD). Only about one-third of subjects were definitely satisfied with the way they were told the diagnosis. Satisfaction was associated with perceived reassurance and sympathy, and with the quality of the information given. The views of patients, as reported in this study, should be taken into account when training staff in the notification of HIV test results.

Health-related quality of life in HIV infection

The need for the quantitative assessment of health-related quality of life is increasingly being recognized in many different areas of health care, particularly in the evaluation of new treatments. This paper addresses the relevance of quality of life evaluation to HIV disease. The first part of the paper discusses the different ways in which quality of life has been defined and considers a number of methodological problems and different theoretical approaches to its measurement. The second part of the paper reviews the existing work on the quantitative evaluation of quality of life in HIV disease, including both descriptive studies and treatment evaluation studies. It is argued that the evaluation of health-related quality of life is important in HIV infection and should become an integral part of future treatment evaluation studies in order to help both clinicians and patients in their decisions concerning available treatment options.

Neuropsychological and Psychiatric Changes following Treatment of ARC Patients with Zidovudine

Six homosexual men with a diagnosis of acquired immunodeficiency syndrome (AIDS)-related complex (ARC- CDC IVA/C2) were assessed with a series of neuropsychological and psychiatric tests prior to commencing treatment with zidovudine and again after 5–6 months. Significant improvements were seen in cognitive functioning, mental state and physical health at the second assessment.