The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: Impact on medical, palliative care, and quality of life outcomes

The effect of highly active antiretroviral therapy (HAART) in the treatment of HIV infection is usually measured by survival, CD4 lymphocyte counts, H IV-1 RNA viral load testing, and the occurrence of opportunistic infections . This pilot study sought to measure the impact of HAART treatments on a wi de range of clinical outcomes and psychological variables in a sample of pa tients with advanced HIV infection. Seventy patients with advanced AIDS who were protease inhibitor naive were started on HAART regimens. Patients wer e admitted to an AIDS inpatient unit of a long-term care facility that prov ides treatment and palliative care. All patients were diagnosed with AIDS, had CD4 cell counts below 300/cc(3) and had a projected survival of greater than one month. Patients were started on triple-drug HAART regimens with d aily medical supervision and observation. In addition to standard clinical and laboratory markers, a series of observer-rated and self-report instrume nts were used to measure various physical and psychological factors (e.g., pain and symptom distress, psychological well-being, depression). Data were collected at baseline and after 1 and 3 months of HAART therapy. As expect ed, the CD4 count increased and viral load levels decreased significantly o ver the 3-month study period. In addition patients improved significantly i n body weight, and serum albumin and ferritin levels. The only psychosocial measure that improved significantly with treatment was depression. Ratings of pain intensity, physical and psychological symptom distress, and overal l quality of life did not change. Of the 70 patients studied, 84.3 % were s till alive after the 3-month study period. Of these, 6 (8.6 %) were dischar ged to community. However 17 surviving patients (24.3 %) had HAART regimens discontinued due to drug intolerance and 11 patients (15.7 %) expired duri ng the study period. While these data are preliminary HAART regimens appear to have positive effects on CD4 count, HIV viral load, and several other m easures of physical well-being in patients with advanced AIDS. Despite thes e improvements, the benefits of treatment on pain and symptom distress, and psychological well-being were less cleat: In addition, treatment failure ( mortality and intolerance) were not uncommon in this sample (40 %). Further research is clearly necessary to better understand the benefits of HAART t herapy in patients with advanced HIV infection. (C) U.S. Cancer Pain Relief Committee, 2001.