Quality of Life Should Be a Central Feature of HIV Management

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 by UNESCO.

"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 Chiron Corporation.]

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.