Abstract: Objectives: Fatigue assessment and its influencing factors in patients infected with HIV/AIDS, who are under antiretroviral treatment and multiexperienced. Method: Prospective study, with descriptive character which included 2 lots of patients, namely 60 persons known to be HIV/AIDS infected for over ten years, with multiple ART schemes in their antecedents as shown by National Institute -Matei Bals- records and 20 other persons, representatives of the general population, uninfected with HIV and without current acute diseases. The study subjects answered standardized self assessment questionnaires on fatigue, pain, adherence to treatment (for HIV infected patients); depression, AIDS Dementia Complex and social status were also evaluated. We considered their haematological (Hb, Hct); and immunological status (CD4, CD8, CD4/CD8 ratio), viral load, hepatic status (TGP, TGO, alkaline phosphatase, GGT, hepatic viruses B and C), thyroid, gonadal and renal functions. Results: Statistical analysis of the data highlighted that the impact of fatigue (at a threshold of 75 points on PEDsQLTM scale) was significantly higher in patients with HIV infection than in persons with no health problems (RR=3.1, p=0.005). Anaemia, thyroid dysfunction, liver or renal impairment were not present in patients accusing fatigue with Karnofsky score>50%. For the patients with Karnofsky score -<50% fatigue was multifactorial. Unlike most studies published in specialty magazines, our study evinces a correlation between the severity of fatigability and viral load (r^2 = 0.17 and p=0.003) or immunological status (r^2 =0.12 and p=0.006). A statistically significant relation between depression and fatigue was noticed. In HIV patients, depression was two times more frequent in those who presented fatigue than in those with no signs of it. In non-HIV patients, depression was discovered in one case and was also associated with fatigue. Likewise, fatigue was linked with patients adherence to treatment, namely patients with a high rate of fatigue (<= 65 points on PEDsQLTM scale) being 42% non-adherent to treatment, while those with no fatigue being 33% non-adherent. Lack of adherence was identified in only 17% of study respondents, with fatigue between the abovementioned values on PEDsQLTM scale. Pain represented a strong interference factor, emphasizing the importance of systematic identification and treatment of all symptoms. Conclusions: In HIV patients, fatigue often stands for a chronic pain, incompletely treated or/and for a hidden depression. Assessment of fatigue and its influencing factors are essential elements of a global therapeutic approach of HIV patients. Proper management of pain and depression, as well as the treatment of fatigue can lead to an improvement in the quality of life and to an increase of adherence to treatment.
read more..