ABSTRACT
Approximately half of all adults living with the Human Immunodeficiency Virus (HIV) experience cognitive alterations related to difficulties in treatment adherence and, therefore, to a significant decrease in quality of life. In this sense, new studies are needed to identify potential mediators related to treatment in this association, such as treatment fatigue. This fact is especially important in at specific groups of individuals with HIV, namely men with HIV who have sex with men (MSM). The objective of this study was to analyze the association between cognitive functioning, Health-Related Quality of Life (HRQoL), and treatment fatigue in MSM with HIV. A cross-sectional study was developed with a sample of 70 MSM, from the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). Participants completed questionnaires related to sociodemographic data, HRQoL, and treatment fatigue in an initial phase; in a second phase, they were administered a computerized cognitive evaluation. Our results demonstrate a significant relationship between a lower cognitive performance in the memory domain and worse HRQoL. Mediation analysis has revealed the total mediation effect of treatment fatigue, specifically, the treatment cynicism domain, on this relationship. This mediation effect remained significant after controlling the sociodemographic and clinical HIV-related variables in the model. No significant mediation effects of the rest of evaluated cognitive domains (attention, perception, reasoning, or coordination) were found in this relationship. The results of this study highlight how MSM with a significant deterioration of memory are at greater risk of developing high levels of treatment fatigue, and, therefore, a lower adherence to the same and a significant deterioration in their HRQoL.
ABSTRACT
Introducción: La disfunción sexual es un síntoma altamente prevalente en lospacientes con insuficiencia renal crónica. En el presente estudio nos proponemosdeterminar la función sexual en los pacientes varones de nuestro programa de hemodiálisis(HD), identificar la naturaleza del problema en caso de disfunción yanalizar su repercusión sobre la calidad de vida relacionada con la salud (CVRS).Métodos: Para ello se estudiaron 103 varones en programa de HD crónica ennuestro Centro. La función sexual y la CVRS se determinaron mediante la cumplimentacióndel test internacional de función eréctil (IIEF) y las láminasCOOP/WONCA respectivamente.Resultados: El 47% de los pacientes carecía de actividad sexual. Estos tenían unaedad más avanzada (p < 0,001), llevaban más tiempo en diálisis (p < 0,01), teníanmayor índice de comorbilidad (p < 0,05) y menores niveles séricos de albúmina(p < 0,05) que los sexualmente activos. Los pacientes activos sexualmente teníanmejor forma física (p < 0,001), estado de salud (p < 0,05) y presentaron menor dificultadpara realizar las actividades cotidianas (p < 0,05) y dolor (p < 0,05) que lossexualmente inactivos. De acuerdo a la puntuación en función eréctil sólo el 40%carecía de problemas de impotencia, el 34,5% padecía una disfunción eréctil leve,el 16,4% moderada y el 9,1% severa. Los principales determinantes para la existenciade actividad sexual fueron la edad, la forma física y el tiempo de permanenciaen HD, explicando entre los tres el 32,7% de la varianza. Existe una correlación estadísticamentesignificativa de la puntuación global del IIEF con las láminas sentimientos(r = -0,34; p < 0,05), actividades cotidianas (r = -0,27; p < 0,05), actividadessociales (r = -0,30; p < 0,05), apoyo social (r = -0,45; p < 0,01) y calidad devida (r = -0,29; p < 0,05). Los pacientes sin actividad sexual no percibieron esta carenciacomo un problema, asimilándola dentro del proceso natural de envejecimiento.Conclusiones: Aunque la disfunción sexual es un problema altamente prevalenteentre los varones en HD, no se asocia necesariamente con un deterioro severoen la CVRS. De hecho, la presencia o no de actividad sexual no presenta efectosignificativo sobre las cosas que uno tiene o desea hacer. Con todo, el pacientesin actividad sexual suele ser mayor, refiere peor estado de salud y presenta másproblemas de funcionamiento físico y a la hora de llevar a cabo las diversas actividadesde la vida cotidiana
Background: The sexual dysfunction is a highly prevalent problem among uremicmen that limits their quality of life. The aim of this study was to determinethe sexual function in chronic renal failure in males patients on hemodialysis andto find the nature of the problem. Also, we explored the impact of sexual dysfunctionon health-related quality of life.Methods: 103 male patients older than 18 years and receiving HD treatmentwere studied. The sexual function was evaluated with the International Index ofErectile Function, and the health-related quality of life was quantified with theCOOP-WONCA Charts, both in their Spanish versions.Results: 47% of the patients didnt have any kind of sexual activity. These onespresented a more advanced age (p < 0,001), a longer stay on dialysis (p < 0,001),a greater comorbidity index (p < 0,05) and smaller levels of seric albumin (p <0,05). The sexually active patients presented a better physical fitness (p < 0,001)and overall health (p < 0,05), and a smaller difficulty to carry out the daily activities(p < 0,05) and pain (p < 0,05). A 40% of the patients with some kind ofsexual function had a good erectile function, the 34,5% suffered a slight erectiledysfunction, the 16,4% a moderate one and the 9,1% a severe one. Multiple linearregression analysis demonstrated that the main determinant of the sexual activitywas the age, followed by the physical fitness and the time on HD (32,7%of the variance explained). We found statistically significative correlation betweenthe total score of IIEF and felings (r = -0,34; p < 0,05), daily activities (r = -0,27;p < 0,05), social activities (r = -0,30; p < 0,05), social support (r = -0,45; p <0,01) and quality of life (r = -0,29; p < 0,05). The patients without sexual activitydidnt perceive their deficiency as a problem and considered this situation inherentto the ageing process.Conclusions: The sexual dysfunction is a highly prevalent problem in the uremicmale, but it doesnt have to be necessarily associated to a serious deteriorationof the HRQOL. In this way, the presence or not of sexual activity doesnt presentsignificant effect on the things that one has or wants to do. With everything,the patient without sexual activity frequently has advanzed age, refers worse stateof health and presents more problems of physical functioning and at the momentof taking to daily activities