PARIS-Physicians need to make a more concerted effort to consider
quality of life issues when devising a management strategy for
patients with HIV-infection, an infectious diseases specialist
said at a conference on cancer, AIDS, and quality of life, sponsored
"Doctors tend to select a treatment based solely on its effectiveness
and side effects profile, and typically fail to consider how it
affects the patient's quality of life," said Sophie Matheron,
MD, of the Department of Infectious and Tropical Diseases, Bichat-Claude
Bernard Hospital, Paris. "This is extremely unfortunate,
since improving quality of life is as significant an objective
of HIV management as is controlling symptoms."
When planning a management strategy, physicians need to ensure
that patients have a "comprehensive understanding" of
the advantages and disadvantages of proposed treatments on specific
quality of life parameters, Dr. Matheron advised. In that way,
the patient is better equipped to choose the treatment that is
suited to the quality of life issues that are most important to
him or her.
Oral vs Intravenous Route
For example, cytomegalovirus retinitis is typically treated with
ganciclovir (Cytovene) administered through a surgically implanted
catheter in the chest.
"After patients are stabilized on intravenous treatment,
they can switch to the oral formulation of the drug," she
said. "The physician needs to inform patients that while
the time to relapse is slightly shorter with the oral drug, the
oral route reduces the risk of serious infections like sepsis
and eliminates the need for an implanted catheter for daily infusions."
[Editors' note: Ganciclovir can now be delivered directly into
the eye via a recently approved implant known as Vitrasert from
When considering oral vs intravenous treatment, physicians need
to discuss effects on quality of life, such as body image and
autonomy, and, secondarily, mobility, Dr. Matheron said. Once
patients are informed about the drug's potential clinical benefits,
side effects, and effects on quality of life, they can then assist
their physician in selecting the most appropriate treatment.