OBJECTIVES: To evaluate the quality of life outcomes in antiretroviral-naive patients randomized to zidovudine plus didanosine versus zidovudine plus didanosine plus nevirapine for treatment of advanced HIV disease (the Istituto Superiore di Sanità 047 trial). DESIGN: A 48-week randomized, double-blind trial. METHODS:Sixty patients were enrolled and evaluated over 24 weeks. Quality of life was assessed using a modified version of the Medical Outcomes Study-HIV Health Survey. For analysis, we calculated two summary scores reflecting the physical (PHS) and the mental (MHS) components of health. RESULTS: Although the three-drug combination was superior at inducing immunologic and virologic responses, the two-drug regimen was superior for both PHS and MHS, especially at week 8 where differences were both statistically and clinically significant (5.8 and 9.2 points, respectively, P< 0.02 for both). Quality of life changes paralleled trends in body weight and Karnofsky performance status score. CONCLUSION: Although a three-drug antiretroviral therapy regimen was superior in terms of short term virologic/immunologic response, the two-drug regimen was better in terms of quality of life. In general, triple therapy remains the most effective treatment option. However, quality of life assessments can yield results that may be discordant with and complementary to those obtained using conventional endpoints. Comparative trials should collect a comprehensive range of outcome measures, including patient-reported quality of life, in order to provide clinicians and patients with additional information that may influence treatment decisions.
RCT Entities:
OBJECTIVES: To evaluate the quality of life outcomes in antiretroviral-naive patients randomized to zidovudine plus didanosine versus zidovudine plus didanosine plus nevirapine for treatment of advanced HIV disease (the Istituto Superiore di Sanità 047 trial). DESIGN: A 48-week randomized, double-blind trial. METHODS: Sixty patients were enrolled and evaluated over 24 weeks. Quality of life was assessed using a modified version of the Medical Outcomes Study-HIV Health Survey. For analysis, we calculated two summary scores reflecting the physical (PHS) and the mental (MHS) components of health. RESULTS: Although the three-drug combination was superior at inducing immunologic and virologic responses, the two-drug regimen was superior for both PHS and MHS, especially at week 8 where differences were both statistically and clinically significant (5.8 and 9.2 points, respectively, P< 0.02 for both). Quality of life changes paralleled trends in body weight and Karnofsky performance status score. CONCLUSION: Although a three-drug antiretroviral therapy regimen was superior in terms of short term virologic/immunologic response, the two-drug regimen was better in terms of quality of life. In general, triple therapy remains the most effective treatment option. However, quality of life assessments can yield results that may be discordant with and complementary to those obtained using conventional endpoints. Comparative trials should collect a comprehensive range of outcome measures, including patient-reported quality of life, in order to provide clinicians and patients with additional information that may influence treatment decisions.
Authors: I Ruiz Perez; J Rodriguez Baño; M A Lopez Ruz; A del Arco Jimenez; M Causse Prados; J Pasquau Liaño; P Martin Rico; J de la Torre Lima; J L Prada Pardal; M Lopez Gomez; N Muñoz; D Morales; M Marcos Journal: Qual Life Res Date: 2005-06 Impact factor: 4.147
Authors: Steven A Safren; Ellen S Hendriksen; Laura Smeaton; David D Celentano; Mina C Hosseinipour; Ronald Barnett; Juan Guanira; Timothy Flanigan; N Kumarasamy; Karin Klingman; Thomas Campbell Journal: AIDS Behav Date: 2012-02
Authors: Andrea Tramarin; Nicoletta Parise; Stefano Campostrini; Donald D Yin; Maarten J Postma; Ramon Lyu; Roberta Grisetti; Amedeo Capetti; Anna Maria Cattelan; Maria Teresa Di Toro; Antonio Mastroianni; Elena Pignattari; Valeria Mondardini; Guido Calleri; Enzo Raise; Fabrizio Starace Journal: Qual Life Res Date: 2004-02 Impact factor: 4.147