[Quality of life, psychological and social aspects in patients with advanced HIV disease].
OBJECTIVE
The advanced HIV infection carries an important physical, psychological and quality of life deterioration for patients. The introduction of new treatment strategies probably implies a global benefit for HIV patients. We carried out this study in order to know in HIV advanced patients; the clinical situation, the prevalence of psychological alterations (anxiety and depression), the quality of life and the impact of the introduction of new antiretroviral drugs about these variables.


METHODS
This is a prospective observational study carried out between January of 1996 and June of 1997 with 52 advanced HIV patients (CD4 cells less than 200/microliter). We carried out 2 clinical interviews with an interval of 12 months being introduced after the first one a change of strategy of antiretroviral treatment. For evaluating the quality of life, the MOS SF-36 was used. The valuation of the anxiety and depression were carried out with the instruments STAI and Beck respectively.


RESULTS
An important physical deterioration was found at the beginning of the study with 84.6% of polisymptomatic patients. We found a high prevalence of anxiety (76.9%) and depression (86.6%) that reaches criteria of graveness respectively in 75% and 25% of the cases. The quality of life was severely affected involving most of the dimensions of the SF-36 scale preserving the social function. The introduction of the change of therapeutic strategy produces a reduction of polisymptomtics patients to 54.8% (p = 0.05), of the graveness of the anxiety (p = 0.009) and depression (p = 0.05) and improving in the perception of general health (p = 0.03) and alterations of physical role (p = 0.02).


CONCLUSIONS
The advanced HIV infection carries a high symptomatic load with a high prevalence of psychological dysfunctions and deterioration of the quality of life. The new strategies of HIV treatment induce a global improvement to the patients, but it makes necessary a better management of the psychological dysfunctions.
Martín Suárez
I
I
Servicio de Medicina Interna, Hospital Juan Ramón Jiménez, Huelva. imsuarez@navegalia.com
Cano Monchul
R
R
Pérez de Ayala
P
P
Aguayo Canela
M
M
Cuesta
F
F
Rodríguez
P
P
Pujol de la Llave
E
E
D000223:Adaptation, Psychological; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001007:Anxiety; D003863:Depression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012959:Socioeconomic Factors