Alexandra Largu

In the HIV/AIDS Regional Center from Iasi, Romania, over 1440 patients are closely followed-up. A small percent <1% (12 patients) of cases are represented by adolescences between 14 and 18 years old. The majority of those (10 cases) are adherent and compliant with the treatment. None of the patients is a drug abuser and one patient acquired the infection through vertical transmission. The COVID-19 pandemic, paradoxically, increased the adherence and compliance to treatment, mainly because it seems that the HIV infected adolescent acknowledge the fact that good health can shield them from an unknown enemy. In these pandemic times, they experienced anxiety and depression, but they kept a closer contact through telemedicine with their physician, and most importantly, they required a sustained session, also through telemedicine, with the psychologist. The red thread of their discussion was focused on their fear, insecurities, and lack of control and the fact that they experienced the feeling of abandonment caused by the absence of interpersonal interaction with their support group.

Looking back into history, infectious diseases played an important role in human history being responsible, in terms of pathologies, for more deaths than any other disease. Considering that infectious diseases have a high rate of transmissibility, with an acute debut and sometimes with a fast evolution to exitus, the impact of the news on families of the departed patient diagnosed with an infectious disease can come as a shock. Processing the unexpected death of a family member needs not only the implication of the physician but also the counseling of a specialized psychologist which can help the families through all stages of loss and grief.

In the last two years the Romanian adult population infected with the human immunodeficiency virus (HIV) has increased due to sexual transmission, both heterosexual and homosexual. The case presented is that of a 33 year-old man, admitted to the Infectious Diseases Hospital in Iasi with acute respiratory failure and a confirmation of Kaposi's sarcoma. Tests later proved positive for HIV, the patient being included in the stage AIDS C3 (acute immunodeficiency syndrome). The respiratory failure was suspected to be caused by Pneumocystis carinii and cotrimoxazol therapy, oxygen therapy and anti-retroviral therapy were established. He was also referred to the oncology hospital for treatment of Kaposi's sarcoma. The patient's adherence to therapy was influenced by a strong doctor-patient relationship, as well as by psychological counseling and support. Creating a functional doctor-patient-psychologist team is key throughout the HIV-positive patient's existence, for supporting long term adherence to therapy and acceptance of the diagnosis. This case highlights the need for a strong psychosocial compartment in every medical center that deals with HIV-infected individuals.

The HIV infected population in Romania is at an age when engaging in a serious relationship is more and more an issue. Dyadic adjustment is the process which most couples go through, in their attempt to form a steady relationship. It is represented by important changes that appear in one's perception of himself and the significant other. Dyadic adjustment can be measured by a series of parameters--couple's satisfaction, couple's consensus, couple's cohesion and expressing emotions. We conducted a study on 60 young men and women (30 male, 30 female). Of these, 45 are in evidence at the laşi Regional Center (22 male, 23 female), the other 15 being their uninfected parteners (8 male, 7 female). They were evaluated using the Dyadic Adjustment Scale, developed by Graham B. Spanier. Most couples enrolled in this study (50%) were sero-concordant (both partners were HIV-positive -15). 26% of couples were made-up an HIV-positive female and a non-infected male, and 24% were made-up of a non-infected female and an HIV-positive male. The median age was 23 years, 33.4% of them came from rural areas. Average schooling level was 6 primary classes, with extremes between two classes of primary and higher education. Only 50% of patients had a job, while the rest had no stable job and were not employed, 33.4% came from broken families or foster care. 100% of HIV infected patients are in active therapy, poliexperimented. Most patients have 5-6 treatment regimens (45%), with a maximum of 8-9 regimens. Most of the couples enrolled (83.3%) were not married, as our study evolved only 5 married couples. The relationship length varied between 4 moths and 15 years. The Dyadic Adjustment Scale revealed high scores in couple's consensus and cohesion for both concordant and discordant couples. In couples where both partners are HIV-positive, the DAS revealed average scores for all four areas of dyadic adjustmet. In Couples where one partner is HIV-positive, and the other is not infected, low scores were seen in emotional expression and in the couple's satisfaction. The HIV infection affects an individual's life and his adjustment to a couple in the sense that a series of factors changes the couple's dynamic--physical and emotional changes specific to the infection and AIDS, ARV treatments' side-effects, the care for the uninfected partner, and preventing HIV transmission through intercourse. All these elements lower the level of dyadic adjustment and increase the level of stress in individuals that are part of an HIV couple.

Quality of life in relation to health is a consequence of disease and treatment on the patient's perception of his ability to have a full and useful life. Due to its nature, the quality of life is a multidimensional and subjective construct, based on the patient's experience. We operationalized the quality of life using the following parameters: CD4 count and HIV viral levels in the patient's blood, the number of days of hospitalization, number of antiretroviral plans, types of side effects and their frequency, psychological issues (anxiety, depression, and neurotic tendencies). We centralized data from a total of 600 patients from the Regional Center in Iaşi in 2010-2011. Side effects accused by the patients emerged from discussions with the infectious disease doctor and psychologist, and psychological aspects were measured by specific instruments (PA Inventory, Beck Depression Scale). Most patients enrolled in the study were male (59%) with mean age of 21.1 years. 34% of them came from rural areas. Average schooling level was 6 primary classes, with extremes between the two classes of primary and higher education. Only 14% of patients had a job, while the rest did not have a stable job or were not employed. 38% came from broken homes or foster care. 85% of patients were in therapy at the time of data centralization. 55% were in the second, third or fourth regimen. 25% were at their first scheme, while 10% in the seventh - eighth scheme. The mean CD4 count ranged between 13 and 269/mmc, while the average viral load varied between 1730 and 3.180.000/mmc. The average number of days of hospitalization was 4. Among the antiretroviral side effects patients complained nausea and vomiting in 85% of cases, lipodystrophy symptoms in 25% of cases, diarrhea 15%. With regard to psychological aspects, 65% of patients showed an above average level of anxiety, 40% showed depressive symptoms, while 10% had specific obsessions-compulsions, and 10% neurotic and hysterical tendencies. By measuring the quality of life through the above parameters, we obtained a clear and comprehensive picture of the situation facing the HIV patient. We believe that close cooperation between the team of doctors and psychologists assisting the infectious patient, on the one hand, and specialists in other medical fields that interact with the patient, on the other hand, can enhance the quality of life of the HIV patient and maintain it at a comfortable level.