A Web-Based Tool for a Complete Evaluation of Fragility in Senior Hiv+ Patients.

BACKGROUND: after the discovery of the antiretroviral therapy, life expectancy of HIV+ patient has become longer and this meant that he would start ageing. International literature demonstrated that the HIV+ patient is more fragile than any other person of the same age and that doesn't present the viral infection. OBJECTIVE: design, development and test of a new web-based instrument to allow the self-administration of the new questionnaire SELFY MPI created during the European project Effichronic. Materials & Methods: between June and September 2018, a group of senior 50 HIV+ patients, was involved. The questionnaire SELFY MPI enables to collect data about quality of life and cognitive functions. RESULTS: the developed web-instrument collects pseudo-anonymous data into the Liguria HIV Network database. The subsequent statistical analysis highlighted a correlation between the two outcomes of SELFY MPI and the laboratory exam's parameter TCD4+ and viral load. CONCLUSIONS: the great potentiality of this instrument is not only the support given to clinical research about the effects of HIV on chronical disease management but it can be also used as a follow-up instrument to evaluate different aspects of the geriatric patient life during the years.

IANUA: a regional project for the determination of costs in HIV-infected patients.

HIV treatment is based on combined antiretroviral therapy (cART) which has substantially improved survival, thus resulting in an increase in patient life expectancy as well as in the cost of HIV-related medical care. Therefore, several cost effectiveness studies were implemented worldwide, with one specifically in the Liguria region (Italy), to compare the annual economic expense in this area for HIV services, and the related improvement in patients' health. The IANUA project is intended to implement both cost-effectiveness and cost-utility analysis, therefore data related to clinical indicators and perceived health status were collected, the latter using a questionnaire based on the EQ-5D-3L. Information about the antiretroviral drugs and the relative quantity that a patient withdraws from the hospital pharmacy every month were extracted from the regional "F-file". All data gathered were stored in the Ligurian HIV Network, a web platform developed by the DIBRIS - Medinfo laboratory. More than eight hundred questionnaires were collected, and data will be elaborated by economists and psychologists. The first statistical elaborations showed that, as expected, costs increased as the number of therapeutic lines increased. Moreover, the average annual costs for patients whose last CD4 values were below 200 cells/mmc corresponded to the maximum expense recorded, however, the cost for patients with final CD4 counts above 500 cells/mmc was not, as expected, the lowest found. This can be explained by the fact that stabilized patients, who had CD4 values below 500 cells/mmc, did not need very expensive care, while patients with CD4 counts above 500 cells/mmc improved their health status thanks to cART.

Quality of life of people living with HIV, preliminary results from IANUA (Investigation on Antiretroviral Therapy) study.

INTRODUCTION: The introduction of combined antiretroviral treatment (cART) has reduced HIV-associated morbidity and mortality, and changed the patients' perspective of life. As a result, Health Related Quality of Life (HRQOL) has become a crucial clinical issue. OBJECTIVE: Assessment of HRQOL in a sample of Italian patients from IANUA study. Investigate correlation between CD4 cell counts, viral load and changes in HRQOL. MATERIALS AND METHODS: EQ-5D-3L self-reported questionnaire has been used in the evaluation of HRQOL. It assesses five dimensions: "mobility," "self care," "usual activities," "pain/discomfort" and "anxiety/depression." Each dimension has three levels: no problems, some problems and extreme problems. In addition, it includes a Visual Analogue Scale (VAS) where one's own health "today" is rated from 0 "worst imaginable health" to 100 "best imaginable health." The respondents provide information on marital status, education, employment/unemployment, other treatments used in addition to HAART (1,2,3,4,5 or more) and number of hospitalizations due to HIV/AIDS. RESULTS: 684 patients completed the questionnaire: 231 females and 453 males. The mean age of the sample was 51 years (range 21-78). The mean VAS score was 69.9. 558 patients (81.5%) reported no problems in mobility. 642 patients (93.5%) had no problems in self care. 423 patients (61.8%) had no pain/discomfort while 219 had some problems. 326 patients (46.1%) had some problems in anxiety/depression. CONCLUSIONS: The analysis of self-reported questionnaires indicates that HRQOL in our sample group is not deeply affected by HIV/AIDS. The dimensions that are affected in the least are "mobility" and "self care" while the major problem is "anxiety/depression" with half of the sample reporting moderate or high level.