PHYSICAL, MENTAL AND SOCIAL WELLBEING IN RELATION TO HAART-ERA LONG-TERM CLINICAL OUTCOMES FOR ADULT PHA

RW Burgoyne
Toronto General Hospital; Department of Psychiatry, University of Toronto, Toronto, Ontario

Objectives: Changes in wellbeing perceptions and relations between wellbeing and clinical status among 41 adult outpatients living with HIV/AIDS (PHA) were assessed over a 4-year period of ‘care-as-usual’.
Methods: Clinical variables (symptoms, CD4 count, Viral Load) and physical, mental and social wellbeing (construct-specific dimensions of the MOS SF-36 and Social Support Survey) were measured in 3 waves (T1, 1997; T2, 1999; T3, 2001), and evaluated for changes among the 3 study time-points using repeated measures analysis of variance with corresponding ‘post hoc’ 1-sample paired t-tests. McNemar Chi-square tests were used to assess changes in proportions of the patient sample with ‘undetectable’ viral load (VL). Associations between wellbeing changes and both immunologic/virologic and symptom changes over time, as well as between final (T3) wellbeing ratings and final clinical status were determined using Pearson product-moment correlation and multivariate linear regression analyses.
Results: Mean 4-year CD4 increase was 196 cells/mL (P<0.0001), corresponding to mean viral load (VL) reduction of 1.4 log₁₀ copies/ml (P<0.0001) and increase in proportion with VL ‘undetectability’ from 32% to 61% (P<0.01). T1-T2 increase in mean number of symptoms was mitigated by T2-T3 symptom reduction. There were no statistically significant changes in any dimension of wellbeing over time. Mental wellbeing scores were consistently lower than general population reference norms. Wellbeing changes were not strongly related to immunologic/virologic changes, but physical and mental dimensions of quality of life were somewhat sensitive to symptom and/or side effect changes, consistent with cross-sectional inverse relations between symptom burden and physical/mental wellbeing. CD4 repletion offset negative effects of symptoms on mental wellbeing.
Conclusions: Wellbeing scores in this sample of PHA were stable over time, a finding that contrasts with pre-HAART longitudinal research. Wellbeing appeared to be influenced more by symptoms and/or side effects than CD4/VL outcomes.

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