To the Editor:
Social and psychological characteristics of partners may influence a person's health status1,2 or even survival.3 According to a recently published paper on HIV-infected persons,4 lack of a stable partnership may be considered an important determinant of clinical progression.
In a study we conducted on women with HIV infection enrolled in the Italian Cohort Naive to Antiretrovirals (ICONA Study), we found that having a current partner who was an intravenous drug user (IDU) was associated with significantly lower levels of psychological well-being even when adjusted for several confounders.
ICONA is an Italian multicenter observational study on the natural history of HIV disease among adults who are naive to antiretrovirals at the time of enrollment. Within the ICONA cohort, the Behavioural Epidemiology (BEHEPI) Study investigates behavioral profile and health status of the enrolled HIV-infected persons. Participants were asked to complete a self-administered questionnaire including items on psychological well-being, personal behavior (self-reported HIV acquisition modality, lifetime number of sex partners, sexual intercourse in the previous 2 weeks, having a current IDU partner) as well as demographic characteristics.5 Psychological well-being was measured through a 5-item scale with 5-point responses (BEHEPI Psychologic Well-Being scale or B-PWBS). Answers to the scale were summed and the result was linearly transformed in a 0-100 score. The scale included the most frequently used items for measuring the psychological well-being and was designed after a focus discussion with HIV experts and people living with HIV infection. We aimed to create a very brief tool for the screening of impaired psychological well-being.
From March 1998 to March 2000, 746 women participated in the BEHEPI Study. Mean age of women enrolled was 32 years (interquartile range [IQR] 28-36), 33% were unemployed, 37% were IDUs, 8% had Centers for Disease Control-defined AIDS: mean of CD4 was 460 (IQR 300-633), and median log of plasma HIV RNA was 4.1 (IQR 3.4-4.7). At enrollment, no woman was receiving antiretroviral therapy. Fifty-five of 746 women (9.7%) reported a current IDU partner. Women with a current IDU partner has a 17-fold probability (95% CI 7.6-38.8; P < 0.0001) of being currently IDU themselves compared with women who did not report a current IDU partner. Fifty-three percent of women had not sexual intercourse in the 2 weeks before the survey.
Missing data for the B-PWB Scale ranged from 4.6% to 5.5% among the 5 items and 7.4% for the whole scale. The validity of the B-PWB scale, evaluated through internal consistency, was good (Cronbach α: 0.81). Median of the B-PWB Scale was 55 (IQR 35-70); 0.5% of patients scored 0 (minimum) and 1.1% scored 100 (maximum).
A multiple linear regression analysis was performed to identify variables independently associated with the B-PWB Scale scores (Table 1). Having a current IDU partner was associated with lowest values on the psychological well-being scale. The multivariate analysis suggested that this association was independent of past or current use of drugs. Results were similar when we considered as IDU only current IDU women (n = 37) (data not shown).
Our results suggest that a focused analysis of familiar and social characteristics of women may be helpful in identifying determinants of health status because even a stable partnership may be associated with a mental health impairment if the partner is a current IDU. Particularly, we suggest that a gender-oriented approach should be used when analyzing social and psychological factors that may influence health outcomes. We did not analyze the potential association of type of partner with clinical course of HIV infection. However, several published papers have demonstrated that depression and mental health impairment are associated with a suboptimal adherence to drugs6 and thus with worse outcomes of therapy.
Maria Stella Aloisi, PhD*
Rita Murri, MD†
Antonella D'Arminio Monforte, MD‡
Davide Bertelli, MD§
Vincenzo Colangeli, MD∥
Francesco Leoncini, MD¶
Giuseppe Ippolito, MD*
Enrico Girardi, MD*
*Istituto Nazionale Malattie Infettive, Spallanzani, Rome, Italy, †Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy, ‡Istituto di Malattie Infettive e Tropicali, Università di Milano, Milan, Italy, §Divisione Malattie Infettive, Spedali Civili di Brescia, Brescia, Italy, ∥Clinica Malattie Infettive, Università di Bologna, Bologna, Italy, ¶Divisione Malattie Infettive, Ospedale Careggi di Firenze, Florence, Italy
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2. Del Aguila MA, Longstreth WT Jr, McGuire V, et al. Prognosis in amyotrophic lateral sclerosis: a population-based study. Neurology
3. Liu L, Sullivan DH. Relationship between social demographic factors and survival within one year of hospital discharge in a cohort of elderly male patients. J Epidemiol
4. Young J, De Geest S, Spirig R, et al. Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV Cohort Study. BMJ
5. Aloisi MS, Serraino D, Girardi E, et al. Sexual behaviour of women living with HIV/AIDS naive for antiretroviral therapy: the ICONA-BEHEPI Study. AIDS Care
6. Ammassari A, Antinori A, Aloisi MS, et al. Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics