A study of the reliability, validity and responsiveness of the HIV overview of problems evaluation system (HOPES) in assessing the quality of life of patients with AIDS and symptomatic HIV infection.

The objective of this study was to evaluate the feasibility, reliability, validity and responsiveness of the HIV Overview of Problems Evaluation System (HOPES) in a Dutch sample. The HOPES was administered three times in a one-year period to a sample of 106 outpatients with a symptomatic HIV-infection (n = 23) or AIDS (n = 83). The HOPES is a self-report HIV-specific quality of life (QOL) questionnaire including five scales: physical, psycho-social and sexual functioning, medical interaction and partner relationship. QOL was also assessed with the EORTC Quality of Life Questionnaire (EORTC QLQ-C30), a 30-item self-report instrument. Clinical data included Centers for Disease Control and Prevention (CDC) stage, date of diagnosis and CD4 cell count. Patients needed approximately 20-30 minutes to complete the questionnaire. The five scales had good internal consistency reliability. Multitrait scaling analysis provided moderate support for item discriminant and convergent validity. The HOPES exhibited adequate levels of construct validity: (1) the inter-scale correlations and correlations with the EORTC QLQ-C30 were in the predicted direction; (2) it discriminated clearly between patients with AIDS and ARC and (3) it was able to document changes in QOL over time. Moreover, the HOPES was responsive to changes in clinical status over time as indicated by CD4 counts. This study provides further evidence of the reliability and validity of the HOPES and shows that this instrument is responsive to changes in CD4 cell counts.

The correlation between neuropsychological and neuroanatomic changes over time in asymptomatic and symptomatic HIV-1-infected individuals.

To determine the relationship between neuroanatomic and neuropsychological changes in both asymptomatic and symptomatic HIV-1-infected individuals, we conducted a longitudinal study of 47 HIV-infected individuals, 15 of whom were asymptomatic and 32 of whom had either AIDS-related complex or AIDS. To measure neuroanatomic change over a 30-month period, we conducted quantitative MRI measures of bicaudate/brain ratio (BCR) and bifrontal/ brain ratio. A comparison of change over time between BCR and neuropsychological performance showed a correlation between increase in atrophy and worsening in certain cognitive functions. The correlation held for both asymptomatic and symptomatic groups, with more pronounced changes in the symptomatic group.

[Between isolation and new hope: the psychosocial status of HIV-infected women]. / Zwischen Isolation und neuer Hoffnung: Die psychosoziale Situation HIV-infizierter Frauen.

HIV-infected women were an increasingly larger group among the risk groups in Germany. In order to illuminate the psychological situation of HIV-infected women in Germany, 100 women with HIV disease were enrolled in a basic study. 72% of the patients were intravenous drug addicted, 28% were infected through other means. The study population comprised patients of all stages of infection. We found 52% in the first stages, 28% in ARC and 20% with AIDS. Evaluated data included medical, socio-demographic, and data regarding the patients' history of drug abuse. The SCL-90-R, a psychological symptom inventory, was applied. Questions about differences between the two groups of HIV-infected women (iv drug addicted vs non-drug addicted) were answered first. Second, we described three clusters of HIV infected women with regard to different levels of psychological distress. Important factors to distinguish between these clusters are the subjective impact of physical distress (e.g. suffering from HIV-associated symptoms) and loss of joy and interest in sex. In order to illuminate the psychosocial situation, we discuss the specific situation of three patients.

Supervised exercise training improves cardiopulmonary fitness in HIV-infected persons.

We attempted to measure cardiopulmonary effects, CD4 counts, and perceived sense of well-being in 25 individuals moderately to severely immunocompromised from HIV infection (mean entry CD4 count = 144.microliters-1) before and after a 24-wk program of exercise training. Only six subjects completed the 24-wk program. All six showed evidence of a training effect. Statistically significant improvements were seen in maximal oxygen consumption (VO2max), oxygen pulse, and minute ventilation. Submaximal exercise performance improved significantly by 12 wk in the 10 individuals available for testing: decreases were seen in heart rate, rate pressure product, and rate of perceived exertion. White blood cell counts and T-lymphocyte subsets were stable at 12 and 24 wk in the subjects available for testing. High depression/anxiety scores on a mental health inventory (General Health Questionnaire) correlated with low CD4 counts. Scores did not correlate with compliance with the exercise program. There was a trend (P < 0.10) for scores to improve over time among those individuals who attended > or = 80% of scheduled exercise sessions. We conclude that exercise training is feasible and beneficial for some HIV-infected individuals.

Cognitive performance in HIV-1 infection: relationship to severity of disease and brain atrophy.

We examined cognitive performance in 72 HIV-1 infected patients and 34 controls. None of the patients had opportunistic infections or unusual neoplasms of the central nervous system (CNS). Factors other than HIV-1 known to cause cognitive decline were excluded from both groups. Cognitive functioning analysed with special emphasis on the severity of HIV infection was related to neuroradiological and immunological findings. In patients with AIDS-related complex (CDC IVa) or AIDS (CDC IVc,d), a deterioration of memory as well as cognitive speed and flexibility was detected. Furthermore, memory deficits were associated with central cerebral and infratentorial atrophy in those patients, while no association was found between cognitive deficits and immunological abnormalities. Patients at CDC stages II or III showed slight association between altered cognitive speed and flexibility and elevated leukocyte count, suggesting a subclinical CNS disease already at early stages of HIV infection.

HIV-illness, social support, sense of coherence, and psychosocial well-being in a sample of help-seeking adults.

This study tests a set of hypotheses that predict self-esteem and anxiety in adults infected with human immunodeficiency virus (HIV). The analysis is motivated by the following question: Is the level of perceived coherence, i.e., the extent to which individuals derive meaning and purpose in their lives despite their HIV-illness, related to their levels of self-esteem and anxiety? Data were obtained from one of three HIV care and referral centers in the Midsouth. The results demonstrate that clients who experienced a greater sense of derived meaning and purpose (perceived coherence) from their situations and those with more confidants (social support) reported higher self-esteem and lower anxiety than other HIV-infected adults seeking counseling and maintenance services. Implications are drawn for strategies to meet HIV-related mental health care needs.

[Asthenic disorders in persons infected with HIV at the initial stages of the disease]. / Astenicheskie rasstroistva u lits, infitsirovannykh VICh, na nachal'nykh stadiiakh zabolevaniia.

Clinical psychopathological, follow-up and neuropsychological evaluation was made for 125 HIV-infected patients in stage 2B of the disease (general lymphadenopathy by V. I. Pokrovskii's classification). It is shown that seropositive subjects had asthenic syndrome for the initial 6 months of the disease. According to the manifestations, asthenia was defined as psychogenic-reactive and organic. In the former variant the treatment involved psychotherapy and occasionally drugs, the latter was treated with chemotherapy and psychopharmacological modalities as the first-line and psychotherapy as adjuvant means. The authors expect that a differential approach to HIV-infection-related asthenia at the disease onset may contribute to better life quality and prognosis in AIDS patients.

Unique patterns of bereavement in HIV: implications for counselling.

OBJECTIVE: The aim of this study was to examine the nature and extent of bereavement problems in HIV + ve clients and the counselling input required. DESIGN: Ninety individuals referred consecutively for counselling by the medical teams after HIV diagnoses were included in the study. Specific bereavement data was gathered by each counsellor according to schedule and semi-structured interviews for all 90 subjects. These data were analysed in conjunction with medical referral letters. SETTING: HIV positive clients attending for treatment at an inner London Hospital. SUBJECTS: The subjects were 91% males and 9% females, mean age 33.82 years (SD 7.2, range 15 to 50 years, mode 28). 44.8% were diagnosed as HIV + ve (asymptomatic), 42.5% had an AIDS diagnosis and the remainder were coded as AIDS Related Complex or unclear. MAIN OUTCOME MEASURES: The subjects were monitored for the presence or absence of bereavement issues, the nature and extent of the reactions and counselling input. The occurrence of single and multiple bereavements was monitored, as were the relationship to the index patient and the health status of the bereaved. RESULTS: Bereavement was mentioned in 28.2% of referrals from medical practitioners yet 43.1% of the patients had been bereaved and used bereavement counselling. 43% spontaneously commenced the session with bereavement issues. They had lost 348 people (average of 12.9 deaths per person reporting). These were overwhelmingly due to AIDS with only 12 (5.6%) not HIV related. 65% linked the bereavement to their own death. Emotional reaction seemed to be independent of the relationship with the deceased but linked with the diagnosis status of the bereaved. CONCLUSION: The emotional consequences of a loss can be severe and long term. The advent of AIDS/HIV has revealed a wave of deaths in a population unused to facing traumatic loss to this extent. There are particular features surrounding AIDS and HIV infection which may differ dramatically from other sorts of loss and challenge previously held notions of bereavement such as the age of the clients, the fact that bereavements are often multiple the illness state of the bereaved person, the taboo surrounding AIDS which often presents barriers to wider social support and the catalogue of losses which any individual has to face. The frequency and high rate of bereavement, often not noted by referrers, suggests similarity with disaster literature in terms of counselling demand.

Spiritual well-being: a predictor of hardiness in patients with acquired immunodeficiency syndrome.

This study examined the relationship between spiritual well-being and hardiness in a group of 100 subjects who either tested positive for the human immunodeficiency virus (HIV+) or who had diagnoses of acquired immunodeficiency syndrome (AIDS)-related complex (ARC) or AIDS. Each subject completed the Spiritual Well-Being Scale, the Personal Views Survey (to measure hardiness), and a Demographic Data Survey. Analysis of data included Pearson Product-Moment Correlation Coefficients and multiple regression techniques. The results demonstrated that there was a significant relationship between spiritual well-being and hardiness (multiple R = .4165; P less than .001) as well as between the existential component of spiritual well-being and hardiness (multiple R = .5047; P less than .001). The conclusions of the study are that in this sample those individuals who were spiritually well and who were able to find meaning and purpose in their lives were also hardier. This finding has significance for the care that is provided to persons who are HIV+ or who have diagnoses of ARC or AIDS.

Changes in neuropsychological performance of AIDS-related complex patients who progress to AIDS.

OBJECTIVE: To investigate the changes in neuropsychological performance associated with progression from AIDS-related complex (ARC) to AIDS. DESIGN: A repeated measures design was used to compare three groups: ARC patients who progressed to AIDS (n = 15), those who did not (n = 19) and seronegative controls (n = 16). METHODS: The three groups were compared on tests of memory, information processing, motor performance, attention and conceptual flexibility. Clinical and immunological characteristics were recorded. Rates of neuropsychological impairment among the three groups were calculated and compared. RESULTS: The only significant difference between the groups at baseline was for one measure of motor performance. Repeated measures analysis indicated that there was a differential rate of change for the three subject groups for tasks of motor performance and attention. ARC patients who progressed to AIDS did not differ significantly from the non-progressors, although both groups showed significant deterioration over time compared with seronegative controls. Although there was a tendency for the progressors to have a higher rate of impairment, there were no consistent significant differences between visits. CONCLUSION: There were no significant changes in performance exclusively associated with progression to AIDS.

Compliance with zidovudine therapy in patients infected with human immunodeficiency virus, type 1: a cross-sectional study in a municipal hospital clinic.

PURPOSE: To determine the extent of and clinical variables associated with zidovudine compliance. PATIENTS AND METHODS: A survey of 83 patients infected with human immunodeficiency virus (HIV) followed in a municipal hospital clinic was performed. Compliance histories were validated by serum and urine zidovudine levels. Patient characteristics included 46% white, 63% with a history of intravenous drug use, and 59% reporting a diagnosis of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). The main outcome measure was greater than 80% compliance with prescribed doses of zidovudine over the previous week. RESULTS: Sixty-seven percent of the study patients reported greater than 80% compliance with prescribed doses of zidovudine over the previous week. The most common explanations given for missing a dose were "forgot to take zidovudine" and "did not have the medication with me." Five variables were independently associated with greater than 80% compliance as determined by stepwise multiple logistic regression: patient belief that zidovudine prolongs life (odds ratio [OR] 9.3, [95% confidence interval (CI) 2.4, 36.7]), a diagnosis of AIDS or ARC (OR 5.5, [CI 1.5, 20.4]), use of a medication timer (OR 4.4, [CI 1.0, 19.1]), no history of intravenous drug use (OR 3.7, [CI 1.0, 14.2]), and taking one to three other medications with zidovudine. CONCLUSIONS: High compliance with zidovudine was achieved by HIV-infected patients in a municipal hospital clinic, many of whom had a history of intravenous drug use. Compliance with zidovudine may be enhanced by a patient's belief that it prolongs life and the use of a medication timer for proper dosing.

[Clinico-experimental study of mental processes in men with HIV infection]. / Kliniko-éksperimental'noe issledovanie psikhicheskikh protsessov u muzhchin, infitsirovannykh VICh.

A total of 55 males aged 19.5 to 62 years who were infected with HIV were examined psychopathologically+ and neuropsychologically by A.R. Luria's methods. Twenty-one of these patients were homosexuals. Syphilis was recorded in 34.7% in this group. Lymphadenopathy was the major clinical sign of HIV infection. Symptoms of organic involvements+ of the central nervous system were revealed by a psychopathological method. Neuropsychological studies detected dysfunction of the right cerebral hemisphere, particularly in a group of homosexuals suffering from syphilis.

Neuropsychological performance in asymptomatic HIV infection.

This study compared 74 human immunodeficiency virus (HIV)-negative and 131 HIV-positive asymptomatic homosexual or bisexual men on an extensive neuropsychological test battery. HIV-positive subjects' performance was significantly worse on verbal memory and psychomotor skills. The prevalence of mild but persistent neurobehavioral impairment in the HIV-positive group was approximately twice that in HIV-negative patients, consistently across several criteria for impairment. There was evidence that degree of neuropsychological impairment was related to patients' perceptions of dysfunction in daily life. Findings were not related to degree of depression or to medication effects. These data suggest that approximately 10% to 20% of HIV-positive asymptomatic men suffer mild neuropsychological impairment that influences their daily lives.

Cognitive impairment in HIV infection.

HIV-infected subjects at various stages of illness but without opportunistic cerebral disease were evaluated using a comprehensive, cognitively-based neuropsychological protocol and measures of levels of depression and anxiety. The data indicated a prominent attentional disorder among impaired subjects; however, language, visual-spatial and memory functioning were not deficient. There was also evidence suggesting executive function deficit. Depression contributed a small additional component in differentiating the groups. These findings help to specify the nature of the cognitive disturbance associated with HIV encephalopathy and are consistent with the pathological effects of primary infection of the brain by HIV. In addition, they provide a specific basis for ameliorative treatment with psychostimulant medication.

Group psychotherapy for HIV-seropositive patients with major depression.

Patients were recruited from the UCLA AIDS Research Center who had previously been referred to psychiatry for participation in an open-label pilot treating patients with major depression with fluoxetine. They chose to participate in group therapy for continuing distress in coping with their HIV-seropositive status, dissolution of their support system, "accepting patienthood," and on being placed on an experimental medical protocol. The group was a closed, twenty-session, homogeneous (for patient characteristics), psychoeducational, supportive, and cognitively oriented psychotherapy group. We found this to be a successful intervention in helping patients manage HIV illness and in providing the coping skills and social support necessary to function at home, work, and in their interaction with their health care providers.

AIDS and social work treatment: a single-system analysis.

This article reports on an exploratory study that examined the efficacy of a social work intervention for people with acquired immune deficiency syndrome (AIDS) and AIDS-related complex. The intervention was based on Heimler's Human Social Functioning theory and method. A single-system design was used to analyze change due to intervention, and two instruments were used to collect data across the phases. The study was replicated with seven subjects; four completed the study, two died, and one withdrew because of physical deterioration. Results indicated that a statistically significant change occurred as a result of intervention for the subjects who completed the study. The intervention facilitated subjects' self-awareness, which led to self-help and a sense of control over their own lives.