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Sleep disturbances in HIV-HCV coinfected patients

indications for clinical management in the HCV cure era (ANRS CO13 HEPAVIH cohort)

Costa, Mariea,,b; Rojas, Teresa Rojasa,,b; Lacoste, Denisc; Villes, Virginiea,,b; Aumaitre, Huguesd; Protopopescu, Cameliaa,,b; Yaya, Issifoua,,b; Wittkop, Lindae,,f; Krause, Jessicag; Salmon-Céron, Dominiqueh,,i; Marcellin, Fabiennea,,b; Sogni, Philippeh,,j,,k; Carrieri, Maria P.a,,b the ANRS CO13 HEPAVIH Study Group

European Journal of Gastroenterology & Hepatology: December 2019 - Volume 31 - Issue 12 - p 1508–1517
doi: 10.1097/MEG.0000000000001441
Original Articles: Hepatology
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Objectives Although common among patients coinfected with HIV and hepatitis C virus (HCV), sleep disturbances (SD) are still poorly documented in this population in the HCV cure era. This longitudinal study aimed at analysing SD in HIV-HCV coinfected patients and identifying their clinical and sociobehavioural correlates.

Methods We used 5-year annual follow-up data from 1047 participants in the French National Agency for Research on Aids and Viral Hepatitis Cohort 13 ‘Hépatite et VIH’ (ANRS CO13 HEPAVIH) cohort of HIV-HCV coinfected patients to identify clinical (medical records) and behavioural (self-administered questionnaires) correlates of SD (mixed-effects logistic regression). SD were identified using one item documenting the occurrence of insomnia or difficulty falling asleep (ANRS ‘Action Coordonnée 24’ self-reported symptoms checklist), and two items documenting perceived sleep quality (Center for Epidemiologic Studies Depression and WHO Quality of Life HIV-specific brief scales).

Results Seven hundred and sixteen (68.4%) patients with completed self-administered questionnaires reported SD at their most recent follow-up visit. In the multivariable model, hazardous alcohol consumption (Alcohol Use Disorders Identification Test-Consumption score ≥ 4 for men, ≥ 3 for women) (adjusted odds ratio = 1.61; 95% confidence interval: 1.09–2.36), depressive symptoms (6.78; 4.36–10.55) and the number of other physical and psychological self-reported symptoms (1.10; 1.07–1.13) were associated independently with SD after adjustment for sex, age and employment status. HCV cure was not associated significantly with SD.

Conclusion SD remain frequent in HIV-HCV coinfected patients and are associated with a series of modifiable behavioural risk factors. Independent of HCV cure, improved screening and comprehensive management of alcohol use, physical and psychological self-reported symptoms and depression are essential in this population. Closer investigation of these risk factors of SDs may both increase sleep quality and indirectly improve patients’ clinical outcomes.

aAix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France

bORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France

cCOREVIH Aquitaine, 33076 Bordeaux, France; Service de médecine interne, hôpital Saint-André, CHU de Bordeaux, 33075 Bordeaux, France

dInfectious and Tropical Diseases Department, Hôpital de Perpignan, Perpignan, France

eUniv. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France

fCHU de Bordeaux, Pôle de santé publique, Service d’information médicale, F-33000 Bordeaux, France

gService Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, 75012 Paris, France

hUniversité Paris Descartes, Paris, France

iService Maladies infectieuses et tropicales, AP-HP, Hôpital Cochin, Paris, France

jINSERM U-1223, Institut Pasteur

kService d’Hépatologie, AP-HP, Hôpital Cochin, Paris, France

Received 6 December 2018 Accepted 24 April 2019

Correspondence to Fabienne Marcellin, PhD, UMR 1252 SESSTIM, Aix-Marseille Univ, Faculté de Médecine, 3e étage, Aile Bleue, 27, Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France Tel: + 33 413 732 279; e-mail: fabienne.marcellin@inserm.fr

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