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