Objective: To assess adherence and quality of life (QoL) in HIV-infected youths simplifying their cART regimen. Methods: Observational, prospective, cohort study conducted on 30 HIV vertically-infected youths of 14 to 25 years of age. All patients had stable undetectable HIV-viral load, were receiving a cART regimen containing Lamivudine, Tenofovir and Efavirenz from a mean of 64 months (SD 14) and were switched to a single-tablet regimen of Efavirenz, Emtricitabina, and Tenofovir. Median of previous cART regimens: 2 (IQR 2-3). Each patient filled out an anonymous 36-items questionnaire to assess self-reported adherence, QoL and symptoms. Depression was evaluated using the CES-D 10. Patients filled out the questionnaire 1 month prior to the therapeutic switch (T-1), at the cART switch (T0) and one month after (T+1). A new questionnaire administration is planned at month 3 and month 6. CD4 count, HIV viral load and other clinical parameters, were collected concomitantly with the questionnaire. Results: 53 % of the patients were orphans of at least one parent, 10% was adopted and 20% lived in foster care. 77 % of the patients completed only the middle school. CDC classifications: N+A 43.3%, B+C 56.7%; current disease stage: N in 86,7% of the patients. 33 % and 76.7% of the patients showed mild to severe signs of atrophy and lipohypertrophy respectively. From To to T+1 all patients retained viral suppression and CD4% increased from 35.2 (SD 8.9) to 39.4 (SD 14.1) (p < 0,05). In the same interval a significant reduction in CES-D 10 score from 8,2 (SD 4.9) to 6.7 (SD 4.4) and in self-perceived physiological fatigue from 4.3 (SD 3.1) to 3.1 (SD 2.2) (p < 0,03) was observed. No differences were observed in adherence level, symptom score and QoL. Conclusions: Simplification to a single-tablet regimen maintains virological suppression, improves immunological response, reduces depression and improves psychological outcomes.
Simplification of combination antiretroviral regimen improves immunological response and depression in a cohort of HIV-infected adolescents / A. Viganò, R. Murri, G. De Matteis, V. Manfredini, C. Mameli, D. Spiri, F. Marinacci, S. Coletto, V. Giacomet, G.V. Zuccotti. - In: HIV MEDICINE. - ISSN 1464-2662. - 10:Suppl. 2(2009), pp. 23-24. (Intervento presentato al 12. convegno European AIDS conference/EACS, tenutosi a Cologne, Germany nel 2009) [10.1111/j.1468-1293.2009.00789.x].
Simplification of combination antiretroviral regimen improves immunological response and depression in a cohort of HIV-infected adolescents
V. Manfredini;C. Mameli;D. Spiri;S. Coletto;V. Giacomet;G.V. Zuccotti
2009
Abstract
Objective: To assess adherence and quality of life (QoL) in HIV-infected youths simplifying their cART regimen. Methods: Observational, prospective, cohort study conducted on 30 HIV vertically-infected youths of 14 to 25 years of age. All patients had stable undetectable HIV-viral load, were receiving a cART regimen containing Lamivudine, Tenofovir and Efavirenz from a mean of 64 months (SD 14) and were switched to a single-tablet regimen of Efavirenz, Emtricitabina, and Tenofovir. Median of previous cART regimens: 2 (IQR 2-3). Each patient filled out an anonymous 36-items questionnaire to assess self-reported adherence, QoL and symptoms. Depression was evaluated using the CES-D 10. Patients filled out the questionnaire 1 month prior to the therapeutic switch (T-1), at the cART switch (T0) and one month after (T+1). A new questionnaire administration is planned at month 3 and month 6. CD4 count, HIV viral load and other clinical parameters, were collected concomitantly with the questionnaire. Results: 53 % of the patients were orphans of at least one parent, 10% was adopted and 20% lived in foster care. 77 % of the patients completed only the middle school. CDC classifications: N+A 43.3%, B+C 56.7%; current disease stage: N in 86,7% of the patients. 33 % and 76.7% of the patients showed mild to severe signs of atrophy and lipohypertrophy respectively. From To to T+1 all patients retained viral suppression and CD4% increased from 35.2 (SD 8.9) to 39.4 (SD 14.1) (p < 0,05). In the same interval a significant reduction in CES-D 10 score from 8,2 (SD 4.9) to 6.7 (SD 4.4) and in self-perceived physiological fatigue from 4.3 (SD 3.1) to 3.1 (SD 2.2) (p < 0,03) was observed. No differences were observed in adherence level, symptom score and QoL. Conclusions: Simplification to a single-tablet regimen maintains virological suppression, improves immunological response, reduces depression and improves psychological outcomes.
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