Abstract
Treatment burden is a multidimensional concept, including several aspects of life of patients affected by chronic conditions. It has been poorly explored in people living with HIV (PLHIV). An online anonymous survey of PLHIV taking antiretroviral therapy (ART) was conducted, in order to investigate the self-reported correlates of disease burden. HIV Treatment and Diseases Burden (TDB) was investigated with a questionnaire containing 31 items in 7 domains. Respondents were stratified in high burden (H-TDB)/low burden (L-TDB) according to overall HIV TDB mean + 1 standard deviation. Factors associated with H-TDB has been evaluated with a logistic regression model. In total, 531 PLHIV completed the questionnaire. 99 PLHIV had a H-TDB (18.6%). PLHIV with H-TDB were younger (p < 0.001), less frequently on current two drug antiretroviral (ARV) regimens (p = 0.01) and more frequently with plasma HIV-RNA >50 copies/mL (p = 0.04). At multivariable regression analysis, younger age (aOR 1.43, 95%CI 1.14–1.80; p = 0.002), not fully treatment satisfaction (aOR 2.19, 95%CI 1.28–3.74; p = 0.004), the need of a more accurate dialogue with treating physician (aOR 2.29, 95%CI 1.21–4.36, p = 0.01) and a self-declared lower overall Health Status (aOR 1.75, 95%CI 1.33–2.32; p = 0.002) were all associated with a H-TDB. One out of five PLHIV showed a high level of treatment and disease burden. Younger age, not fully satisfaction with ART and need of interaction with a tailored health system should be taken into consideration as correlates of treatment and disease burden in a patient-centered approach, to reduce the negative impact that it can produce on the overall perceived health status of the person.
Highlights
Forty years have passed since the first detection and isolation of the human immunodeficiency virus (HIV), but HIV still remains a global public health issue with 1.5 million of new HIV infection/year, a total of 37.7 million of people living with HIV (PLWH) in 2020 and 27.5 million of subjects on active antiretroviral therapy
680,000 PLWH dying from HIV/AIDS globally in the year 2020 (64% fewer than in 2004 and 47% fewer than in 2010) [1]
The antiretroviral therapy has allowed to achieve substantial benefits over the years, in terms of prevention of new infections, life-expectancy and long-term management of the infection, but this should not cancel the actual difficulty of living with a chronic condition as HIV
Summary
Forty years have passed since the first detection and isolation of the human immunodeficiency virus (HIV), but HIV still remains a global public health issue with 1.5 million of new HIV infection/year, a total of 37.7 million of people living with HIV (PLWH) in 2020 and 27.5 million of subjects on active antiretroviral therapy. Complications of residual inflammation or immunodeficiency such as cardiovascular diseases, cognitive disorders and cancers are rising in importance; the cumulative exposure to potentially toxic antiretroviral (ARV) drugs can led to clinically relevant disturbances (such as metabolic, liver, renal complications). This multimorbidity and related polypharmacy associated with HIV could deeply affect a healthy ageing for PLWH [2]. In addition to common aspects of other chronic diseases, HIV has important social, behavioral and stigma-related implications that can significantly impact the perceived and experienced burden by people living with
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