Everything fine so far? Physical and mental health in HIV‐infected patients with virological success and long‐term exposure to antiretroviral therapy

• Published in: Journal of the International AIDS Society Vol. 17; no. 4 Suppl 3; pp. 19673 - n/a
• Main Authors: Erdbeer, Gesa, Sabranski, Michael, Sonntag, Ina, Stoehr, Albrecht, Horst, Heinz‐A., Plettenberg, Andreas, Schewe, Knud, Unger, Stefan, Stellbrink, Hans‐J., Fenske, Stefan, Hoffmann, Christian
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.11.2014; John Wiley & Sons, Inc
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral drugs; Drug therapy; Energy loss; Exposure; HIV; Human immunodeficiency virus; Mental depression; Patients; Quality of life; Sexual behavior; Sexually transmitted diseases; STD; Success
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.17.4.19673

Introduction Little is known about the well‐being on long‐term exposure to antiretroviral therapy. The ACTG Augmented Symptoms Distress Module (ASDM) is a validated tool which measures the presence of a total of 22 symptoms seen with HIV and quantifies the extent to which they cause distress to the patient. Methods ELBE was a cross‐sectional study that consecutively included adult HIV‐infected patients presenting with viral suppression (<50 HIV RNA copies/mL) and ART exposure for at least five years. Patients were evaluated by four different questionnaires, including ASDM. Results Of a total of 894 patients included in the three participating ELBE centres, complete data on ASDM were available for 698 patients (626 male, 69 female, 3 transsexual). Median age was 49.7 years (range, 23.3–82.5 years) and median exposure to ART was 11.5 years (range, 5–28 years). Median CD4 T‐cell counts had increased from a CD4 nadir of 180 to currently 640 cells/µL. Despite immunological and virological success, a high degree of symptom‐related distress was noted in this patient population. In total, 63.8% and 36.3% of the patients had at least one “bothersome” or one “very bothersome” symptom, respectively. The symptoms most frequently reported to be “bothersome” or “very bothersome” were fatigue and energy loss (18.5% and 11.0% respectively), insomnia (12.8% and 11.6%), sadness and depression (13.0% and 10.0%), sexual dysfunction (12.0% and 10.0%), and changes in body appearance (11.0% and 10.9%). There was no association between the degree of symptom‐related distress and gender, age or CD4 T‐cell nadir. However, the history of AIDS‐defining illnesses, comorbidities such as depression but also the duration of ART were significantly associated with a higher overall symptom summary score and with a higher frequency of symptoms. For example, in patients with at least 15 years of ART exposure, only 27.3% of the patients did not report at least one “bothersome” or “very bothersome” symptom. Conclusions In this large group of positively selected HIV+ patients with virological success and long‐term exposure to ART, a high degree of symptom‐related distress was found. Medical care of HIV‐infected patients should not only focus on optimal virological outcome. More data on quality of life in patients with long‐term exposure to ART is needed.