The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: Impact on medical, palliative care, and quality of life outcomes
Jr. Brechtl et al., The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: Impact on medical, palliative care, and quality of life outcomes, J PAIN SYMP, 21(1), 2001, pp. 41-51
Citations number
48
Categorie Soggetti
General & Internal Medicine","Neurosciences & Behavoir
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.