Abstract #130  -  Physical and psychological symptoms and risk of virological rebound among patients with virological suppression on ART
Authors:   Presenting Author:   Prof Lorraine Sherr - University College London
Additional Authors:  Dr Fiona Lampe, Dr  Richard Harding, Dr C Smith, Prof M Johnson, Prof A Phillips,
Aim: To examine the association of patient-reported physical and psychological symptoms, demographics, adherence and mental health at baseline with subsequent virological rebound at 2 year follow up among patients with successful initial viral suppression on combination antiretroviral therapy (cART).
Method / Issue: 86% of all patients agreed to participate. Inclusion criteria included English fluency, agreement to follow up, on current treatment with successful viral suppression. We studied 188 eligible HIV patients from a routine London clinic, who completed a questionnaire on HIV/health issues in 2005, and were on cART, with VL<50c/mL. Six symptom measures were defined, based on the Memorial Symptom Assessment Scale Short Form (MSAS-SF), and additional questions: 1) physical symptom score; 2) psychological symptom score; 3) global symptom score; 4) total numbers of symptoms 5) depression/anxiety; 6) suicidal thoughts. Associations with time to subsequent VL>200c/mL were assessed, considering each symptom measure separately.
Results / Comments: Of 188 patients, 22 (11.6%) experienced VL>200c/mL (mean follow-up: 2.1 years). Symptom measures 1 to 5 were strongly related to risk of viral rebound: risk was increased four to five-fold in the highest compared to lowest tertiles for the MSAS scores and total number of symptoms, and almost four-fold for patients with anxiety/depression compared to others (p=0.005 to p=0.034, measures 1-5). There was a weaker, non-significant association with measure 6 (suicidal thoughts). Associations remained with some attenuation after adjustment for demographic and treatment-related factors, and after additional adjustment for subject-reported non-adherence. A sensitivity analysis using VL>50c/mL (46 rebounds) produced similar results (p=0.007 to p=0.042, measures 1-5).
Discussion: Among patients with viral suppression on ART, physical and psychological symptoms were strong predictors of viral rebound. This study underlies the importance of good psychosocial routine measurement. It also shows that simple symptom assessments may be valuable in the clinical setting to identify patients at risk of treatment failure, and provide opportunity for intervention.
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