P3. Integrated analysis of biomedical and quality of life data in the InfCare HIV system

Gaetano Marrone 1, Åsa Mellgren 2, Elisabeth Palmryd 3, Lars Eriksson 1,4, Veronica Svedhem Johansson 1

Affiliates: 1Department of Medicine, Division of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden. 2Clinic of Infectious Diseases, South Älvsborg Hospital, Borås, Sweden 3Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 4School of Health Sciences, City University London, United Kingdom

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Background
New evidence suggests that individuals with HIV, who are diagnosed early in the course of infection and have access to ART, have a life–expectancy almost equivalent to the general population. Since life expectancy is increasing, it is of great importance to assess how HIV impacts on the individuals’ quality of life.
This project presents integrated analysis of the national Swedish treatment results and the self-reported Health Care Questionnaire from 2011 to 2013. The purpose was to study the association between socio-demographic and biomedical data, treatment outcome, self reported adherence, and psychological and physical satisfaction in order to identify interventional possibilities for improvement in the health care of HIV infected patients on a group level.

Material and methods
Health Care Questionnaire
In 2008, a working group of doctors, nurses, a psychologist and patient organization representative developed a self-reported health care questionnaire to assess Patients ´wellbeing, ART adherence and side effects. All patients were invited to answer the questionnaire (available in English or Swedish) yearly from 2011. Two thousand eight hundred forty-six (2,846) patients from 30 HIV units in Sweden answered the health questionnaire during 2011 to 2013, while 171 patients declined participation.

Results
The mean age among the participants was 47 years; two third (67%) were men. The most common estimated routes of transmission were heterosexual (49%), homosexual or bisexual (40%) and injecting drugs (6%). The majority of the participants were born outside Sweden (57%).
Satisfied with body and psychological health
The patients were generally pleased with their health: throughout the study period 63% were satisfied or very satisfied with body health, with the percentage increasing from 2011 to 2013. Patients who have been infected for a longer time and have been more time on HIV treatment were less satisfied with body health, even after adjusting by age (p=0.002). Sixty percent (60%) were satisfied or very satisfied with their psychological health.
Treatment and satisfaction

Ninety-three percent (93%) reported to be on HIV treatment, with the percentage increasing from 2011 to 2013.
Patients taking HIV treatment were more satisfied with psychological health compared to patients not taking treatment, but there was no difference in reported body health between groups.
Adherence and satisfaction
Eighty-seven percent (87%) of all patients reported that they had not missed any dose of HIV medication the week before interview; 11% had missed 1-2 doses and 2% had missed more than 2 doses. Adherence also improved with time. Older patients and patients born in Sweden had better self reported adherence compared to younger and immigrants.
Significant differences in viral load between different adherence groups were found: 93% of the patients reporting not missed any doses had VL 2 doses had VL<50, (p=0.001).
Patients reporting not missed any dose were more satisfied with physical (p=0.016) and psychological (p=0.010) health.

Conclusions
The Swedish InfCare cohort demonstrates a significant improvement in adherence, viral suppression and quality of life between 2011 and 2013. Despite this, they have a significantly reduced self-reported physical and psychological health compared to general Swedish population and patients with other chronic diseases.