Araceli Rousaud

Factors Associated with Severe Impact of Lipodystrophy on the Quality of Life of Patients Infected with HIV-1

A standardized questionnaire was used to assess the impact of lipodystrophy (LD) on quality of life (QoL). Eighty-four consecutive asymptomatic human immunodeficiency virus type 1 (HIV-1)-infected outpatients with clinical LD completed a modified version of the Dermatology Life Quality Index (DLQI) survey to measure the impact of body fat changes on their QoL. Body changes influenced dressing for 55 patients (65%), produced feelings of shame for 41 (49%), and disrupted sexual life for 23 (27%). There was a greater impact on the DLQI due to body changes among women, injection drug users, patients with abdominal or breast lipoaccumulation, and patients with a high number of non-LD side effects. Multivariate proportional odds model analysis showed that the severity of non-LD-associated side effects and the presence of breast lipoaccumulation were associated with impaired psychosocial functioning. Specific characteristics of patients, antiretroviral-based side effects, and breast lipoaccumulation exert a greater impact on QoL in HIV-1-infected patients with LD.

Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz.

Objective: To assess baseline variables able to predict neuropsychiatric side effects (NPSEs) associated with the initiation of an efavirenz (EFV)‐containing regimen in HIV‐1‐infected patients. Design: Open‐label, prospective, observational study. Methods: Consecutive HIV‐1‐infected outpatients in whom EFV was prescribed underwent a psychiatric interview. At baseline and at 2, 4, and 12 weeks, patients completed the Symptoms Check List‐90‐Revised (SCL‐90‐R), the Medical Outcome Study for HIV‐positive patients (MOS‐HIV), and a standardized questionnaire concerning potential NPSEs. Results: Preliminary data showed that discontinuation of EFV because of NPSEs occurred in 4 of 31 patients (13%). Patients who completed the follow‐up showed a decrease in SCL‐90‐R total score (p = .004) and in several subscales such as Interpersonal Sensitivity (p = .009), Depression (p = .001), and Anxiety (p = .040), whereas no changes in MOS‐HIV were observed. Having fewer years of education (p = .006), having fewer baseline central nervous symptoms (p = .000), reporting better baseline physical status (p = .013), and having higher baseline scores in the Heath Transition subscale of the MOS‐HIV (p = .000) and in the Somatization subscale of the SCL‐90‐R (p = .002) were associated with more NPSEs. Conclusion: Patients maintained on EFV showed a decrease in psychologic distress related to self‐image, depression, and anxiety, without any effect on quality of life. Patients with a lower level of education, those who feel physically and psychologically better at baseline than in the past, and those who suffer from more distress as a result of physical complaints may be at greater risk of reporting more NPSEs after EFV initiation.

Impact of lipodystrophy on the quality of life of HIV-1-infected patients

INTRODUCTIONnLipodystrophy (LD) represents an important problem for HIV-1-infected patients receiving highly active antiretroviral therapy (HAART), although its impact on quality of life (QoL) has not been properly studied.nnnDESIGNnCross-sectional, nonrandomized, observational study performed on consecutive, clinically stable outpatients taking HAART for more than 1 year.nnnMETHODSnData on patients characteristics, HIV-1 infection, treatment adherence and adverse effects, overall QoL measured by the Profil der Lebensqualität Chronischkranker (PLC), and the presence of LD defined by clinical criteria were assessed.nnnRESULTSnEighty-four (56%) of 150 interviewed patients fulfilled criteria for LD. Patients with LD were older, had been taking antiretroviral treatment longer, and reported a poorer physical status than patients without LD. Surprisingly, LD itself was not found to influence overall QoL. However, homosexual patients, unemployed patients, and those patients undergoing current psychiatric treatment showed greater impairment on some of the QoL subscales related to psychological well-being if they suffered from LD.nnnCONCLUSIONnThe impact of HIV-related LD on QoL depends on certain patient characteristics, rather than on the presence of LD itself.

A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study

Background Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. Methodology We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. Findings Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (pu200a=u200a0.21) and compliance levels >90% (pu200a=u200a0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. Conclusions Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. Trial Registration Clinical-Trials.gov: NCT01117675.

Assessment of the Efficacy of a Cognitive-Behavioural Group Psychotherapy Programme for HIV-Infected Patients Referred to a Consultation-Liaison Psychiatry Department

Background: Most HIV-infected patients attending a consultation-liaison psychiatry service show symptoms of anxiety and depression. The present study sought to evaluate the immediate and long-term efficacy of a structured cognitive-behavioural group therapy reducing anxiety and depression in HIV-infected patients referred to a consultation-liaison psychiatry department, and to identify baseline variables predictive of greater improvement. Methods: Repeated-measures ANOVA was used to analyse changes in the Beck Depression Inventory (BDI) and the state subscale of the State/Trait Anxiety Inventory (STAI) administered to 39 participants at 4 time points: T1 (1 month before beginning the therapy), T2 (during the first session), T3 (during the last session) and T4 (3 months after the last session). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioural group psychotherapy programme. Results: During the intervention time (between T2 and T3) an improvement was observed in depression and anxiety, which persisted after the 3-month follow-up period (between T3 and T4). No changes were observed during baseline (between T1 and T2). Patients with higher levels of anxiety at baseline showed greater improvement in STAI state subscale scores. Transmission of HIV infection through intravenous drug use was associated with less improvement on the BDI. Conclusions: This is the first report of an ongoing study which suggests long-lasting efficacy of a structured cognitive-behavioural group psychotherapy programme in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.