E-health. Patterns of use and perceived benefits and barriers among people living with HIV and their physicians. Part 2: Health apps and smart devices.

OBJECTIVES: To evaluate patterns of use and perceived benefits and barriers to health/wellness applications (apps) and smart devices among people living with HIV (PLHIV) and their physicians. METHODS: Online multicenter observational survey (October 15-19, 2018). RESULTS: Study participation was accepted by 229 physicians and 838/1377 PLHIV followed in 46 centers, of which 325 (39%) responded online. Overall, 83/288 (29%) PLHIV had already downloaded at least one app: these 'downloaders' were younger (OR0.96±0.01, P=0.004), educated to at least university entry level (OR2.27±0.86, P=0.03), and more frequently used geolocation-based dating websites (OR3.00±1.09, P=0.002). However, 227/314 (72%) PLHIV claimed they were ready to use an app recommended by a physician. For the 60/83 PLHIV who answered, the ideal app would be a vaccination tracker (76%) to better communicate with their physician (68%). However, 96/277 (42%) physicians were unable to answer this question and for 94/227 (41%) of them, the ideal patient app would be for schedule management. Although PLHIV used smart devices, 231/306 (75%) would want to report the data to their physicians and 137/225 (61%) of physicians would welcome this exchange. The main physician-side barrier to this exchange was concerns over data security. CONCLUSION: mHealth apps and smart devices have failed to garner adoption by PLHIV. There is a case for good-quality health data sharing and exchange if PLHIV are provided with appropriately secure tools and physicians are backed up by adapted legislation.

E-health. Patterns of use and perceived benefits and barriers among people living with HIV and their physicians. Part 1: Information retrieval on the Internet and social networks.

OBJECTIVES: To identify patterns of use, perceived benefits, and barriers among people living with HIV (PLHIV) of online searches for health information and via social media. METHODS: Online multicentre observational survey (October 15th-19th, 2018). RESULTS: Study participation was accepted by 838/1377 PLHIV followed in 46 centres, of which 325 (39%) responded online: 181 (56%) had already used the Internet to search for health information; 88/181 (49%) on HIV infection and 78 (43%) on nutrition. These 56% were characterised by a higher educational level (OR=1.82±0.50; P=0.028) and more often consulted other specialists (OR=3.14±1.26; P=0.004). A subset of 87/180 (48%) PLHIV had changed the way they looked after their health based on their online research, and were more often in material/social deprivation (P=0.02) and diabetic (P=0.02). A small subset of 19/180 (11%) had already asked or answered a question on a forum; these people tended to be women (P=0.03) in material/social deprivation (P=0.009). 296/322 (92%) PLHIV trusted their physician whereas only 206 (64%) trusted information sourced on medical websites. 238/323 (74%) PLHIV expected their physicians to recommend websites if asked, whereas only 23/323 (7%) had actually been given this guidance. CONCLUSION: More than half of PLHIV surveyed had already searched for health information on the Internet, and one in two had changed their behaviour based on the online search. PLHIV did not see the Internet as an alternative to physicians but they wanted their physicians to guide them on how to find quality health information to better self-manage their condition.

E-health. Patterns of use and perceived benefits and barriers among people living with HIV (PLHIV) and their physicians - Part 3: Telemedicine and collection of computerized personal information.

OBJECTIVES: To evaluate the patterns of use and perceived benefits and barriers among people living with HIV and their physicians concerning telemedicine and the collection of computerized personal information. METHODS: Multicenter online observational survey from October 15 to 19, 2018. RESULTS: Study participation was accepted by 229 physicians and 838/1,377 PLHIV followed in 46 centers, of which 325 (39%) responded online. We found that while 226/302 (75%) PLHIV accept online prescription renewals and 197/302 (65%) accept online medical certificates, 182/302 (60%) PLHIV-who were more often in material/social deprivation (OR=1.70±0.45; P=0.045), less often born in Île-de-France (OR=0.43±0.15; P=0.018), with lower CD4 T-cell counts (OR=0.999±0.0004; P=0.038), and less often on psychiatric treatment (OR=0.50±0.18; P=0.047)-were receptive to teleconsultations. However, 137/225 (61%) physicians would be uncomfortable teleconsulting due to inadequate data security without it reducing the number of consultations or offering economic benefit. Asked about collection of computerized personal information, 197/296 (67%) PLHIV and 139/223 (62%) physicians agreed it improved quality of care, but 144 (49%) PLHIV and 94/222 (42%) physicians thought it was not sufficiently framed by the law. eHealth was seen as improving coordination between health professionals by 240/296 (81%) PLHIV and seen as a good thing by 181/225 (81%) physicians. CONCLUSION: More than half of PLHIV were ready for telemedicine. PLHIV and physicians endorsed the advantage of e-health in terms of better coordination across health professionals but mistrust the data collection factor, which warrants either clarification or stronger legal protections.

[Cognition disorders in HIV infection. Validation of a brief neuropsychological evaluation battery]. / Troubles cognitifs au cours de l'infection par le VIH. Validation d'une batterie courte dévaluation neuropsychologique.

UNLABELLED: The objective of our study was the elaboration and the validation of a brief neuropsychological battery sensitive to the main cognitive and psychomotor deficits in HIV+ patients with HIV encephalopathy and cognitive impairment associated with seropositivity. We evaluated the sensitivity of this brief battery with respect to a large neuropsychological battery of standardized tests. METHODOLOGY: A brief battery (BB) (30 mn, with simple and portable material) of 5 standardized subtests and 7 new elaborated tests and a large battery (LB) (2 h to 2 h 30) of 16 standardized subtests, were constituted. Both screened 6 major cognitive areas (attention, memory, visuospatial function, psychomotor speed, motor dexterity, language). On the LB, subjects' age and educational level were considered while appraising performances to determine whether subjects had normal cognitive status (less than 4 abnormal test scores), borderline cognitive impairment (4 or 5 abnormal test scores); on the BB norms for the new tests were generated from the results of 24 HIV+ subjects with normal cognitive status on the LB and 15 HIV- subjects of a control group; performance on the BB was considered normal if less than 3 test scores were abnormal, or impaired if more than 3 test scores were abnormal. Conclusions deduced from the assessments with BB were compared to those obtained from LB. For all subjects, a possible anxio-depressive component was evaluated on the basis of DSM III-R criteria and clinical scales (MADRS and STAXI). Subjects were included in the study notwithstanding mode of contamination and stage of illness and anxiodepressive antecedents; patients with identified brain disease or evolutive non neurological pathology were not included. 102 evaluations were performed on a population of HIV+ patients comprising 89 men and 13 women: 19 CDC II, 35 CDC III or IV C 2 and 48 CDC IV; 76 homosexuals, 8 heterosexuals, 16 drug users and 2 transfused. RESULTS: the BB led to the same conclusions for 90.6% of the 53 impaired cases (on LB) and for 96% of the 24 normal cases. The reliability of the BB is therefore of 92%; there was only 1 false positive (less than 2%) and less than 6.5% false negatives. Among the 25 subjects with borderline cognitive impairment, half were impaired and half were normal on the BB; most (84%) presented with anxio-depressive symptoms. COMMENTS AND CONCLUSION: The brief battery (BB) testing 6 cognitive functions could be considered as a sensitive, practical instrument for rapid detection of cognitive impairment in HIV+ patients, with a few rate of false positive or negative diagnosis. However, it is not adequate for determining whether psychiatric or/and organic brain pathology is at the origin of the deficit. Evaluation and follow-up of a possible anxio-depressive component has to be considered together before concluding.

[Anxious-depressive state and cognitive deficit in HIV infection]. / Statut anxio-dépressif et déficit cognitif au cours de l'infection par le VIH.

UNLABELLED: This study tries to demonstrate the importance of using follow-up trials and taking anxio-depressive status into account while interpreting cognitive impairment in HIV-infected subjects. Subjects included were: 18 HIV carriers, mostly homosexual, belonging to CDC groups II (4), III or IVC2 (7) and IV (7), selected within a cohort of 63, as having been assessed 3 times, with no focal or identified brain disease at entry. Our methods were: 1) psychiatric interview based on DSM III-R criteria, clinical scales (Spielberger's STAXI and the MADRS) and cognitive questionnaires; 2) neuropsychological evaluation including 16 subtests screening attention, memory, visuo-spatial function, motor dexterity, psychomotor speed, and language; 3) repeated assessment within a period ranging from 6 to 21 months. RESULTS: At entry, cognitive status was impaired for 14 subjects (2 II, 5 III or IVC2, 7 IV). Disorders had disappeared for 7 subjects (2 II, 2 IVC2 and 3 IV) at following assessments allowing us to conclude on a psychogenic origin. For 7 subjects, cognitive status had either remained constant (3 III and 2 II) or had worsened within 7 to 17 months (2 IV), whereas psychiatric symptoms had decreased, implying HIV encephalopathy. Follow-up trials including 3 neuropsychological and psychiatric assessments and neuroimagery, if necessary, were required to ascertain the causes of cognitive impairment consequently attributed to anxio-depressive symptoms or HIV encephalopathy in 14 subjects.

[Neurospychiatric symptoms in HIV infected patients and the role of efavirenz]. / Troubles neuropsychiatriques chez les patients infectés par le VIH et rôle de l'efavirenz.

Efavirenz has now become commonly used to treat HIV infection. Neuropsychiatric disorders have been reported in patients treated with efavirenz. Several factors often make it hard to determine the cause of these disorders: HIV infected patients take many different drugs, they may suffer from various organ diseases, and may also be heavily affected by problems in their everyday life. The French experts group working on neuropsychiatric side effects of efavirenz has undertaken a review of these disorders with the aim to identify: (1) semiology, (2) epidemiology in the global population, in HIV infected patients, and in patients treated with efavirenz. The expert group suggests recommendations to manage these disorders.

Sexual dysfunction in 156 ambulatory HIV-infected men receiving highly active antiretroviral therapy combinations with and without protease inhibitors.

We conducted a cross-sectional study of 156 ambulatory HIV-infected homosexual or bisexual men to assess and compare the prevalence and characteristics of sexual dysfunction according to treatment combinations (group A, protease inhibitor [PI] treatment; group B, no PI treatment; and C, PI treatment interrupted >1 month previously). The study was based on a self-administered 163-item questionnaire that included a French translation of the International Index of Erectile Function, five sections of the Derogatis Sexual Functioning Inventory, and open questions. Data analysis was performed using Mann-Whitney and Kruskal-Wallis H nonparametric tests (quantitative values) and chi2 tests (qualitative values) using SPSS software (SPSS, Chicago, IL, U.S.A.). One hundred fifty-six patients completed the study. The median age +/- SD of the patients was 40.5 +/- 7.7 years, and the median CD4+ cell count +/- SD was 415 +/- 236/mm3. One hundred eleven (71%) of 156 patients reported some degree of sexual dysfunction since the beginning of their treatment (65 [71%] of 91 group A patients; 15 [65%] of 23 group B patients; and 31 [74%] of 42 group C patients), with no significant difference among the groups. Of the 111 patients, 99 (89%) reported decrease or loss of libido, 76 (68%) reported orgasmic perturbation, 96 (86%) reported erectile dysfunction, and 65 (59%) reported ejaculation perturbation, with no significant difference among the three groups. There were no significant differences among the three groups regarding the International Index of Erectile Function and Derogatis Sexual Functioning Inventory scores. These data suggest that PI-based therapy does not seem to increase sexual dysfunction in this patient population.