Role of antidepressants in relieving the impact of fatigue in HIV-HCV co-infected patients: results from the HEPAVIH French cohort (ANRS Co13)

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”.
Conclusions: 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.

L. Michel1,2,3, V. Villes4,5,6, F. Dabis7, B. Spire4,5,6, M. Winnock7, M.-A. Loko7, I. Poizot-Martin8, M.-A. Valantin9, P. Bonnard10, M. Bentata11, D. Salmon-Céron12, M.-P. Carrieri4,5,6
1INSERM U669, Paris, France, 2Université Paris-Sud and Université Paris Descartes, UMR-S0669, Paris, France, 3AP-HP, Hôpital Emile Roux, Centre de Traitement des Addictions, Limeil-Brévannes, France, 4INSERM, U912 (SE4S), Marseille, France, 5Université Aix Marseille, IRD, UMR-S912, Marseille, France, 6ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France, 7INSERM U897, Bordeaux, France, 8CHU Sainte Marguerite, Marseille, France, 9CHU de la Pitié Salpétrière, Paris, France, 10Hôpital Tenon, Paris, France, 11Service de Médecine Interne, Hôpital Avicenne, Bobigny, France, 12Hôpital Cochin Port-Royal, Paris, France