Parcours de soins des patients relevant des soins palliatifs hospitalisés à domicile (expérience de 95 patients du service d hospitalisation à domicile du centre hospitalier de Périgueux, de janvier 2004 à août 2008)

L'objectif de notre travail était d'analyser le parcours des 95 patients relevant des soins palliatifs (SP) pris en charge par le service d'Hospitalisation à Domicile (HAD) du Centre Hospitalier de Périgueux, de janvier 2004 à août 2008, au travers des dossiers médicaux. Nos résultats ont été illustrés par les entretiens guidés de 7 médecins généralistes. Ces patients sont des patients complexes, requérant une démarche de soins particulière, car ils présentent souvent des cancers à des stades avancés et une autonomie faible. Ils ont donc bénéficié de soins lourds et multiples. La présence de proches et la conservation d'une certaine autonomie sont nécessaires au maintien à domicile. Les ruptures du maintien à domicile les plus fréquentes étaient les hospitalisations conventionnelles (HC), fréquemment motivées par des problèmes médicaux aigus. Les difficultés de la fin de vie à domicile en lien avec la famille étaient toutefois non négligeables. La fin de vie à domicile a été étudiée selon 3 pistes de réflexion : l'utilisation des morphiniques qui concernait plus de la moitié des patients et surtout ceux porteurs de cancers, l'emploi des prescriptions anticipées personnalisées, utilisées essentiellement pour le contrôle de la douleur et l'évaluation du niveau de formation dans le domaine des SP des médecins généralistes qui était insuffisant de leur point de vue. A la fin de la période d'étude, 75 % des patients étaient décédés, le plus souvent en établissements de soins. Peu étaient maintenus à domicile par d'autres moyens que l'HAD. Les autres étaient admis en HC. La plupart des médecins considérait que favoriser le décès à domicile était une avancée importante dans le domaine de la santé, en précisant les préalables et les difficultés de ce projet. Les médecins interrogés dressaient en général un bilan positif de leur expérience au sein du service d'HAD, en exprimant leurs attentes, notamment quant aux séjours de longue durée et la création de lits d'accueil d'urgence.Our work was aimed at analysing, thanks to their medical files, the treatments provided by the Hospital-at-home service of Périgueux Hospital to 95 patients benefiting from palliative care, from January 2004 to August 2008. Our results have been illusttrated by the guided interviews of 7 GPs. These patients face serious and complex illness and require particular care, since they often have advanced stage cancers and a poor autonomy. They have consequently benefited from extensive care. They need relatives and some autonomy to be looked after at home. The most frequent breaks of home care were conventional hospitalizations, usually caused by acute medical problems. Nevertheless, the difficulties of the end of life at home with the family were to be considered. End of life at home has been studied according to three points : the use of opioids, which concerned more than half of the patients and marticularly cancer carriers ; the use of personalized anticipated prescriptions, essentially used to control pain, and the assessment of the GPs' skills in palliative care, which they considered as insufficient. At the end of the study, 75 % of the patients were dead, most of the time in hospitals. Few of them were cared at home by other means than Hospital at Home. The others were hospitalized. Most of the GPs considered that favouring death at home was an important progress in Health, despite the prerequisites and difficulties of this project. The doctors interviewed usually drew a positive assessment of their experience in the Hospital-at-home service, and expressed their expectations as regards long stays and the creation of emergency hospital beds.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Factors associated with poorer quality of life in people living with HIV in southwestern France in 2018–2020 (ANRS CO3 AQUIVIH-NA cohort: QuAliV study)

Abstract We evaluated people living with Human Immunodeficiency Virus’ (PLWH) quality of life (QoL) and assessed whether their demographic, disease-related, socioeconomic, or behavioral characteristics were associated with poorer QoL. ANRS CO3 AQUIVIH-NA cohort participants (Nouvelle Aquitaine, France) were recruited to a cross-sectional study (2018–2020) and their QoL assessed (WHOQOL-BREF). We calculated median (Q1, Q3) QoL domain scores and assessed factors associated with poorer median QoL using bivariable and multivariable quartile regression. Of the 965 PLWH included, 98.4% were on antiretroviral therapy, 94.7% were virally-suppressed, 63.5% reported good/very good QoL. Median scores (0–100) were highest for physical (69;Q1, Q3: 56, 81) and environmental (69; 56, 75) QoL and lowest for social (56; 44, 69) and psychological (56; 44, 69) QoL. PLWH with ≥ 3 comorbidities, HIV-related stigma, or income of < 1500€/month had poorer median adjusted physical, psychological, social, and environmental QoL scores compared to reference groups. While more than half of PLWH reported good/very good QoL, we have not achieved good QoL in 90% of PLWH. Multi-morbidity, HIV-related stigma, and social determinants were consistently and independently associated with poorer QoL. Addressing structural factors in addition to those indirectly related to HIV is required to attain good QoL in all PLWH

A comprehensive analysis of excess depressive disorder in women and men living with HIV in France compared to the general population

International audienceAbstractWe aimed to estimate the prevalence of depressive disorder in people living with HIV (PLWH) and evaluate its association with non-HIV-specific and HIV-specific factors in PLWH and in PLWH compared to the general population (GP). We used cross-sectional data from the QuAliV study, conducted within the ANRS-CO3 Aquitaine-AQUIVIH-NA cohort of PLWH in Nouvelle-Aquitaine (2018–2020), and a nationally-representative survey in the GP (EHIS-ESPS, 2014–2015), we included all participants aged ≥ 18 years old who had completed the Patient Health Questionnaire-8 (PHQ-8). Depressive disorder was defined as Patient Health Questionnaire-8 score greater or equal to 10. Its association with non-HIV-specific (demographic, socio-economic, behavioral, health status), HIV-specific factors (immuno-viral markers, antiretrovirals, level of perceived HIV-stigma), and HIV-status was assessed using Poisson regression models with robust variance in women and men separately. We included 914 PLWH (683 men/231 women). More than one in five PLWH had depressive disorder. It was strongly associated with being younger and experiencing severe pain in both sexes. Unemployment in women, being single, and lack of family ties in men were also associated with depressive disorder. More than 30% of our sample reported HIV-stigma, with a dose–response relationship between level of perceived HIV-stigma and depressive disorder. The crude prevalence of depressive disorder was 2.49 (95%CI 1.92–3.22) and 4.20 (95%CI 3.48–5.05) times higher in women and men living with HIV respectively compared to GP counterparts and 1.46 (95%CI 1.09–1.95) and 2.45 (95%CI 1.93–3.09) times higher after adjustment for non-HIV specific factors. The adjusted prevalence ratio of depressive disorder was not significantly different in HIV-stigma free women, but remained twice as high in HIV-stigma free men. The prevalence of depressive disorder compared to the GP tended to decrease with age in PLWH. Excess depressive disorder remains a major concern in PLWH. Our findings reaffirm the importance of regular screening. Tackling social inequalities and HIV-stigma should be prioritized to ensure that PLWH achieve good mental as well as physical health outcomes

Tobacco, alcohol, cannabis, and illicit drug use and their association with CD4/CD8 cell count ratio in people with controlled HIV: a cross-sectional study (ANRS CO3 AQUIVIH-NA-QuAliV)

Abstract Background To evaluate drug use (alcohol, tobacco, cannabis and other drugs) and its association with mean CD4/CD8 T cell count ratio, a marker of chronic inflammation, in virally suppressed people living with HIV-1 (PLWH) in Nouvelle Aquitaine, France. Methods A multi-centric, cross-sectional analysis was conducted in 2018–19 in the QuAliV study—ANRS CO3 AQUIVIH-NA cohort. Tobacco, alcohol, cannabis, and other drug use (poppers, cocaine, amphetamines, synthetic cathinones, GHB/GBL) were self-reported. CD4 and CD8 T cell counts and viral load measures, ± 2 years of self-report, and other characteristics were abstracted from medical records. Univariable and multivariable linear regression models, adjusted for age, sex, HIV risk group, time since HIV diagnosis, and other drug use were fit for each drug and most recent CD4/CD8 ratio. Results 660 PLWH, aged 54.7 ± 11.2, were included. 47.7% [315/660] had a CD4/CD8 ratio of < 1. Their mean CD4/CD8 ratio was 1.1 ± 0.6. 35% smoked; ~ 40% were considered to be hazardous drinkers or have alcohol use disorder; 19.9% used cannabis and 11.9% other drugs. Chemsex-associated drug users’ CD4/CD8 ratio was on average 0.226 (95% confidence interval [95% CI] − 0.383, − 0.070) lower than that of non-users in univariable analysis (p = 0.005) and 0.165 lower [95% CI − 0.343, 0.012] in multivariable analysis (p = 0.068). Conclusions Mean differences in CD4/CD8 ratio were not significantly different in tobacco, alcohol and cannabis users compared to non-users. However, Chemsex-associated drug users may represent a population at risk of chronic inflammation, the specific determinants of which merit further investigation. Trial registration number: NCT03296202

Tobacco, alcohol, cannabis, and illicit drug use and their association with CD4/CD8 cell count ratio in people with controlled HIV: a cross-sectional study (ANRS CO3 AQUIVIH-NA-QuAliV)

International audienceBackground: To evaluate drug use (alcohol, tobacco, cannabis and other drugs) and its association with mean CD4/CD8 T cell count ratio, a marker of chronic inflammation, in virally suppressed people living with HIV-1 (PLWH) in Nouvelle Aquitaine, France. Methods: A multi-centric, cross-sectional analysis was conducted in 2018–19 in the QuAliV study—ANRS CO3 AQUIVIH-NA cohort. Tobacco, alcohol, cannabis, and other drug use (poppers, cocaine, amphetamines, synthetic cathinones, GHB/GBL) were self-reported. CD4 and CD8 T cell counts and viral load measures, ± 2 years of self-report, and other characteristics were abstracted from medical records. Univariable and multivariable linear regression models, adjusted for age, sex, HIV risk group, time since HIV diagnosis, and other drug use were fit for each drug and most recent CD4/CD8 ratio. Results: 660 PLWH, aged 54.7 ± 11.2, were included. 47.7% [315/660] had a CD4/CD8 ratio of < 1. Their mean CD4/CD8 ratio was 1.1 ± 0.6. 35% smoked; 40% were considered to be hazardous drinkers or have alcohol use disorder; 19.9% used cannabis and 11.9% other drugs. Chemsex-associated drug users’ CD4/CD8 ratio was on average 0.226 (95% confidence interval [95% CI] − 0.383, − 0.070) lower than that of non-users in univariable analysis (p = 0.005) and 0.165 lower [95% CI − 0.343, 0.012] in multivariable analysis (p = 0.068). Conclusions: Mean differences in CD4/CD8 ratio were not significantly different in tobacco, alcohol and cannabis users compared to non-users. However, Chemsex-associated drug users may represent a population at risk of chronic inflammation, the specific determinants of which merit further investigation. Trial registration number: NCT03296202. © 2023, The Author(s)