Quality of Life Should Be a Central Feature of HIV Management

PARIS-Physicians need to make a more concerted effort to considerquality of life issues when devising a management strategy forpatients with HIV-infection, an infectious diseases specialistsaid at a conference on cancer, AIDS, and quality of life, sponsoredby UNESCO.

"Doctors tend to select a treatment based solely on its effectivenessand side effects profile, and typically fail to consider how itaffects the patient's quality of life," said Sophie Matheron,MD, of the Department of Infectious and Tropical Diseases, Bichat-ClaudeBernard Hospital, Paris. "This is extremely unfortunate,since improving quality of life is as significant an objectiveof HIV management as is controlling symptoms."

When planning a management strategy, physicians need to ensurethat patients have a "comprehensive understanding" ofthe advantages and disadvantages of proposed treatments on specificquality of life parameters, Dr. Matheron advised. In that way,the patient is better equipped to choose the treatment that issuited to the quality of life issues that are most important tohim or her.

Oral vs Intravenous Route

For example, cytomegalovirus retinitis is typically treated withganciclovir (Cytovene) administered through a surgically implantedcatheter in the chest.

"After patients are stabilized on intravenous treatment,they can switch to the oral formulation of the drug," shesaid. "The physician needs to inform patients that whilethe time to relapse is slightly shorter with the oral drug, theoral route reduces the risk of serious infections like sepsisand eliminates the need for an implanted catheter for daily infusions."

[Editors' note: Ganciclovir can now be delivered directly intothe eye via a recently approved implant known as Vitrasert fromChiron Corporation.]

When considering oral vs intravenous treatment, physicians needto discuss effects on quality of life, such as body image andautonomy, and, secondarily, mobility, Dr. Matheron said. Oncepatients are informed about the drug's potential clinical benefits,side effects, and effects on quality of life, they can then assisttheir physician in selecting the most appropriate treatment.

Indeed, it is not surprising that a quality of life assessmentis frequently not carried out in HIV-positive patients, Dr. Matheronsaid. Most trials of treatments for HIV and opportunistic infectionshave focused on the clinical, immunologic, and antiviral effectsof the drug, while quality of life issues such as the patient'ssense of well-being or self-perception have not been systematicallyassessed, she noted.

"Thus, physicians do not have a scientifically proven method-aquestionnaire, for example-for evaluating quality of life in theirpatients," she said.

Finally, Dr. Matheron pointed out that some studies that havelooked at quality of life issues in HIV-positive patients haveregrettably used questionnaires that were developed for cancerpatients. This approach, she emphasized, is not valid, since thetwo conditions are very different.

"They have a different pathogenesis, and AIDS is, in fact,a syndrome rather than a disease," she said. "What'smore, the affected populations are different (in terms of age,ratio of males to females, and socioeconomic status), and thesocietal response and approach to death are different betweenthe two groups."