Marseille 2007
| Abstract #194 - Positive impact on quality-of-life of a switch from a virologically effective regimen to a regimen containing efavirenz or nevirapine. | ||||
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Session: 42.7: Wellbeing and quality of life (Parallel) on Tuesday @ 16.30-18.30 in Auditorium/Overflow Chaired by Anna Liguori, Richard Harding Authors: Presenting Author: Ms COSTAGLIOLA DOMINIQUE - INSERM U720, France |
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| Additional Authors: Ms Valrie Potard, MD Olivier Chassany, MD Marc Lavignon, MD Bruno Spire, | ||||
| Aim: Switching antiretroviral therapy has been shown as safe and effective, but its impact on quality-of-life (QoL) was rarely measured. Our objective was to assess the effect on quality-of-life, anxiety, depression and perceived symptoms of a switch to a NNRTI containing regimen in NNRTI naive HIV-infected patients with viral load (VL) <500 copies/ml. | ||||
| Method / Issue: Patients were followed at month 1 (M1), 6 (M6) and 12 and results are available up to M6. The WHOQOL questionnaire was used to assess QoL in 6 domains (physical, psychological, level of independence, social relationships, environment, spirituality) with scores ranging from 4 to 20. The HAD scale was used to assess anxiety and depression. A symptom questionnaire including 9 items on lipodystrophy and 21 on others symptoms was also used. The mean change from baseline of QoL scores and number of symptoms were compared using the paired Wilcoxon test, while groups receiving each NNRTI were compared using the Mann-Whitney test. The effect sizes were calculated for QoL domains for which the change was significant. Changes in the percentage of patients with anxiety or depression were tested using the McNemar test. | ||||
| Results / Comments: Among 232 patients enrolled, 161 were followed up to 6 months and with questionnaires at baseline and M6, among which 68% received nevirapine. At baseline, the median duration of ARV exposure was 2.0 years, the median CD4 count 438 cell/mm3, 32% of patients were at AIDS stage. All patients had a VL < 500 copies/ml except one (732 copies/ml). Baseline characteristics were similar in the 2 NNRTI groups. The means of scores for each domain were 14.8 for physical, 14.4 for psychological, 14.5 for level of independence, 14.7 for social relationships, 14.8 for environment, and 14.2 for spirituality. The percentage of anxious patients was 16.8% and 15.4% of patients were depressive. Patients reported a mean of 11.8 symptoms (7.8 bothersome), 3.3 lipodystrophy symptoms (2.0 bothersome) and 8.6 others symptoms (5.8 bothersome). At M6, 5 patients had a VL > 500 copies/ml (3%). An improvement in QoL was found statistically significant for the physical domain (+ 0.61 point), the psychological domain (+0.37 point), the level of independence (+0.80 point), environment (+0.37 point), and spirituality (+0.67 point), with effect sizes showing a small benefit in terms of physical domain (0.27), level of independence (0.29), and spirituality (0.23). The improvement was already seen at M1. The mean of number of symptoms (-3.1), lipodystrophy symptoms (-0.8), others symptoms (2.4), bothersome symptoms (-1.7), bothersome lipodystrophy symptoms (-0.4) and bothersome other symptoms (-1.3) decreased significantly at M6 (p<0.01) and the change was already significant at M1. The percentage of anxious patients diminished at M6 (10,7%, P=0.02) but not yet at M1. There was no change in the percentage of patients with depression. Results were similar for efavirenz and nevirapine exposed patients. | ||||
| Discussion: In patients with controlled VL, switch to a NNRTI regimen was associated with a small improvement of the quality-of-life, a diminished number of perceived symptoms and of the level of anxiety while maintaining virological suppression. | ||||
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