09-P09 - SESSTIM
Transcription
09-P09 - SESSTIM
Background: Fatigue is a major component of quality of life (QOL) and is associated with depression in HIV-HCV co-infected individuals. Our aim was to assess whether treating depression could mitigate the impact of fatigue on daily functioning even in patients with advanced HIV or HCV disease. Methods: The analysis was conducted on enrolment data of 328 HIV-HCV co-infected patients recruited in the French nationwide HEPAVIH cohort, neither presenting opportunistic infections nor receiving HCV treatment. Data collection was based on medical records and self-administered questionnaires which included socio-behavioural data, the fatigue impact scale (FIS) on three domains (cognitive, physical and social functioning), self-reported and depressive symptoms (DS) (CES-D) and use of antidepressants (AD). A multivariate analysis of variance (MANOVA) was used to identify factors associated with the impact of fatigue on the three domains. Results: Median[IQR] FIS scores were 9[2-18] for cognitive impact of fatigue and 10[4-21] and 17[4-37] respectively for physical and social impact of fatigue. Median[IQR] CD4 cell count was 444[292-643]/mm3, 86% of patients had undetectable HIV viral load, 91% were receiving HAART and 41% presented DS. After adjustment for gender and unemployment, CD4 cell count<200/mm3 was associated with a negative impact of fatigue (p=0.002) on the physical functioning dimension. A higher number of symptoms causing discomfort significantly predicted a higher impact of fatigue on all dimensions (p<0.001). This was also true for patients with no DS receiving AD when compared with those with DS treated with AD. A significant decreasing linear trend (p<0.001) of the impact of fatigue was found across the categories “DS/AD”, “DS/no AD”, “no DS/AD” and “no DS/no AD”. Conclusion: Systematic screening for depression followed by combined management of depression, fatigue and perceived symptoms can potentially improve the QOL of HIV-HCV co-infected patients and relieve the burden of living with a dual infection. Key words: depression, fatigue, HIV, HCV, HAART, self-reported symptoms, maintenance therapy. ABSTRACT CDB044 Role of antidepressants in relieving the impact of fatigue in HIV-HCV co-infected patients: results from the HEPAVIH French cohort (ANRS Co13) L. Michel1,2,3, V. Villes4,5,6, F.Dabis7, B. Spire4,5,6, M. Winnock7, MA. Loko7, I. Poizot-Martin8, MA. Valantin9, P. Bonnard10, D. Salmon-Ceron11, MP. Carrieri4,5,6 AUTHORS Statistical methods and patients The 3 fatigue scores were used as a multiple response variable in a MANOVA (multivariate analysis of variance) to take into account the inter-correlations between them 1 INSERM U669, Paris, France 2 Université Paris-Sud and Université Paris Descartes, UMR-S0669, Paris, France 3 AP-HP, Hôpital Emile Roux, Centre de Traitement des Addictions, Limeil-Brévannes, France 4 INSERM, U912 (SE4S), Marseille, France 5 Université Aix-Marseille, IRD, UMR-912, Marseille, France 6 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France 7 INSERM U897, Bordeaux, France 8 CHU Sainte Marguerite, Marseille, France 9 CHU de la Pitié Salpétrière, Paris, France 10 Hôpital Tenon, Paris, France 11 Hôpital Cochin-Port-Royal, Paris, France Explanatory variables were considered eligible for the final model when their p-value based on F-test (Wilks’ lambda) was lower than 0.25 for at least one dimension of the FIS Fatigue is one of the most frequently reported symptoms in patients with VHC, its prevalence ranging between 50% and 67% Background Fatigue is functionally associated with depression and is a core symptom in the diagnosis of major depressive disorder (DSM-IV) Selection criteria Patients neither presenting opportunistic infections nor receiving HCV treatment and who filled in the self-administered questionnaire (N=328) In HIV-HCV co-infected patients, fatigue may be aggravated by additional factors such us the burden of HIV disease, the psycho-social vulnerability of this group (mainly drug users) and their exposure to multiple treatments and drugs (Braitstein, 2005) No significant differences, except for age, were found between socio-demographic and clinical characteristics of patients with complete data (N=328) compared to those with incomplete data (N=194) For these patients, fatigue is also a major component of quality of life (Marcellin, 2007) Objecti ve To assess whether treating depression could mitigate the impact of fatigue on daily functioning even in patients with advanced HIV or HCV disease HEPAVIH French Cohort Study (ANRS CO13): design Started in 2006, participating of 17 different hospital out-patient facilities providing care for people living with HIV and HCV with a follow-up of at least 5 years Individuals can be enrolled at any time during their HIV-HCV history Exclusion criteria: undetectable HCV viral load for more than 6 months after commencing treatment for HCV (SVR) Methods Data collection Clinical and biological data including plasma HIV RNA, CD4 cell count, and liver fibrosis were obtained from medical records The self-administered questionnaire included items on sociodemographic characteristics, treatment history and ongoing treatments, alcohol and tobacco consumption and drug use The self-administered questionnaire also collected psychosocial data such as depressive symptoms (DS) (CES-D) and use of antidepressants (AD), patients’ perceptions concerning the impact of fatigue on their daily functioning (FIS) and self-reported side effects Outcome Patients’ perceptions about the “impact” of fatigue on their daily lives over the previous month were collected using the self-reported Fatigue Impact Scale (FIS) 3 fatigue scores: cognitive, physical and social impacts of fatigue ranging from 0 to 40 (0 to 80 for social impact) Higher scores denote higher perceived impact of fatigue Explanatory variables Depression was measured by using the validated CES-D scale with a cut-off of 17 for men and 23 for women (Fuhrer and Rouillon, 1989) Self-reported side effects included 39 different symptoms over the previous four weeks and the discomfort they caused (Justice, Holmes et al. 2001) Re sults Characteristics of participants (n=328) Age (years) Men HIV transmission group IDU Homosexual Heterosexual Other Having children High school certificate Employment Living in a couple Comfortable housing conditions Cognitive impact of fatigue (0-40) Physical impact of fatigue (0-40) Social impact of fatigue (0-80) No DS* and no AD No DS* and AD DS* and no AD DS* and AD Number of self-reported side effects Number of self-reported side effects causing discomfort Polydrug use (>=1) Daily alcohol consumption Cannabis use CD4 cell count/mm3 Nadir CD4 cell count/mm3 Undetectable plasma HIV RNA ASAT (UI/l) ALAT (UI/l) Cirrhosis n (%) or Median [IQR] 42 [40-46] 229 (69.8) 206 (63.6) 42 (13.0) 38 (11.7) 38 (11.7) 104 (32.4) 93 (30.5) 151 (47.3) 147 (45.7) 264 (81.0) 9 [2-18] 10 [4-21] 17 [4-37] 173 (53.2) 21 (6.5) 89 (27.4) 42 (12.9) 7 [1-14] 2 [0-8] 37 (11.3) 29 (9.0) 150 (45.7) 444 [292-643] 153 [69-244] 277 (85.5) 50 [36-73] 59 [36-88] 90 (27.4) * Cut-off of 17 for men and 23 for women Factors not associated with the 3 fatigue impact scores (p>0.25) Daily alcohol consumption Heroin use Polydrug use Receiving HAART ASAT Factors associated with the 3 fatigue impact scores (p<0.25) Women No child(ren) No high school certificate Unemployed Not living in a couple Uncomfortable housing conditions No DS and no AD No DS and AD DS and no AD DS and AD (reference) Cannabis use History of IDU Receiving OST Nb. of self-reported side effects causing discomfort CD4<200 cell count/mm3 HCV genotype 1 or 4 ALAT (UI/l) B Coefficients: Cognitive Physical Social Impact Impact Impact 3.1 ** 3.1 ** 6.6 ** 4.3 ** 4.5 ** 8.4 ** 2.2 * 5.2 ** 1.9 N 5.5 ** 6.1 ** 12.7 ** 2.9 ** 3.4 ** 6.7 ** 4.5 ** 4.1 ** 10.9 ** -14.3 ** -14.3 ** -30.1 ** -9.5 ** -11.0 ** -20.3 ** -4.6 ** -5.2 ** -10.2 ** 2.7 ** 1.4 N 3.8 ** 2.6 ** 2.3 * 5.9 ** 5.9 ** 5.2 ** 10.4 ** 0.92 ** 2.0 N 1.9 N -0.008 N 1.04 ** 4.2 ** 2.3 N -0.014 N 1.76 ** 4.3 N 4.4 * -0.028 * ** p<0.05; * p<0.10; N=not associated Factors independently associated with the 3 fatigue impact scores Women Unemployed No DS and no AD No DS and AD DS and no AD DS and AD (reference) CD4<200 cell count/mm3 Nb. of self-reported side effects causing discomfort Adjusted B Coefficients: Cognitive Physical Social Impact Impact Impact 1.8 ** 2.0 ** 4.3 ** 1.6 * 2.1 ** 5.0 ** -10.8 ** -9.9 ** -23.3 ** -6.6 ** -7.5 ** -15.6 ** -3.5 ** -4.1 ** -8.4 ** 1.6 N 4.3 ** 3.7 N 0.71 ** 0.85 ** 1.27 ** ** p<0.05; * p<0.10; N=not associated C O N C L U S I O N S - Women and individuals with severe immunosuppression seem to perceive the impact to fatigue to a greater extent - Special individualised interventions to limit the impact of fatigue should be envisaged in these populations before and during HCV treatment - Systematic screening for depression followed by combined management of depression and perceived symptoms can improve the QOL of HIV-HCV co-infected patients and relieve the burden of living with a dual infection Acknowledgements Principal investigators: D. Salmon-Ceron, F. Dabis Methodology: F. Dabis, M. Winnock Management Center: M. Winnock, MA. Loko, L. Dequae Merchadou, S. Gillet Hepatology: Y. Benhamou, P. Sogni Virology: J.Izopet, M-E.Lafon Social Sciences: B. Spire, MP. Carrieri, P. Roux, L. Michel, V. Villes, M. Mora, P. Kurkdji List of participating groups: (ANRS CO13 HEPAVIH) AC7 cohorts: AQUITAINE (F. Dabis), RIBAVIC (F. BaniSadr), SEROCO/HEMOCO (L. Meyer) Clinical Centers: Paris: Hôpital Cochin - Service de Médecine Interne 2, Hôpital Tenon - Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière - Service des Maladies Infectieuses, Hôpital Avicenne - Service de Médecine Interne, Hôpital Bichat-Claude Bernard - Service des Maladies Infectieuses A, Hôpital de Bicêtre - Service de Médecine Interne , Hôpital Necker-Enfants Malades - Service des Maladies Infectieuses, Hôpital Saint Antoine - Service des Maladies Infectieuses, Hôpital Saint Louis - Service de Médecine Interne, Hôpital Paul Brousse - Service des Maladies Infectieuses ;Marseille: Hôpital Sainte Marguerite - Service Hématologie et VIH ; Nice: Hôpital de l'Archet - Services des Maladies Infectieuses et de Médecine Interne ; Toulouse: Hôpital Purpan - Services des Maladies Infectieuses et de Médecine Interne, Hôpital Joseph Ducuing - Service de Médecine Interne; Bordeaux: Hôpital Pellegrin - Services des Maladies Infectieuses A et B, Hôpital Saint André Service de Médecine Interne, Hôpital Haut Lévêque Service de Médecine Interne A Associated team: UMR912 INSERM-IRD-Université de la Méditerranée A special thank to all people living with HIV and HCV who accepted to participate in the study Financial Support: Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS)