The Impact of Combination Antiretroviral Therapy and its Interruption on Anxiety, Stress, Depression and Quality of Life in Thai Patients

Reto Nüesch*, 1, 2, §, Angèle Gayet-Ageron3, §, Ploenchan Chetchotisakd4, Wisit Prasithsirikul5, Sasisopin Kiertiburanakul6, Warangkana Munsakul7, Phitsanu Raksakulkarn8, Somboon Tansuphasawasdikul9, Sineenart Chautrakarn1, Kiat Ruxrungtham1, Bernard Hirschel3, Jintanat Anaworanich1
1 HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
2 Division of Infectious Diseases University Hospital Basel and Hirslanden Clinic St. Anna Lucerne, Switzerland
3 Division des Maladies infectieuses, Geneva University Hospital, Switzerland
4 Khon Kaen University, Khon Kaen, Thailand
5 Bamrasnaradura Institute, Nonthaburi, Thailand
6 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
7 Metropolitan Administration Medical College and Vijira Hospital, Bangkok, Thailand
8 Sanpatong Hospital, Chiang Mai, Thailand
9 Buddhachinnaraj Hospital, Phitsanulok, Thailand

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© Nüesch et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Hirslanden-Clinic St. Anna, St. Anna Street 32, CH-6006 Lucerne, Switzerland; E-mail:
§ Both authors have equally contributed to the manuscript



Investigation on anxiety, stress, depression, and quality of life (QoL) within STACCATO, a randomised trial of two treatment strategies: CD4 guided scheduled treatment interruption (STI) compared to continuous treatment (CT).


Thai patients with HIV-infection enrolled in the STACCATO trial.


Anxiety, depression assessed by the questionnaires Hospital Anxiety and Depression Scale (HADS) and DASS, stress assessed by the Depression Anxiety Stress Scale (DASS), and QoL evaluated by the HIV Medical Outcome Study (MOS-HIV) questionnaires. Answers to questionnaires were evaluated at 4 time-points: baseline, 24 weeks, 48 weeks and at the end of STACCATO.


A total of 251 patients answered the HADS/DASS and 241 answered the MOS-HIV of the 379 Thai patients enrolled into STACCATO (66.2 and 63.6% respectively). At baseline 16.3% and 7.2% of patients reported anxiety and depression using HADS scale. Using the DASS scale, 35.1% reported mild to moderate and 9.6% reported severe anxiety; 8.8% reported mild to moderate and 2.0% reported severe depression; 42.6% reported mild to moderate and 4.8% reported severe stress. We showed a significant improvement of the MHS across time (p=0.001), but no difference between arms (p=0.17). The summarized physical health status score (PHS) did not change during the trial (p=0.15) nor between arm (p=0.45). There was no change of MHS or PHS in the STI arm, taking into account the number of STI cycle (p=0.30 and 0.57) but MHS significant increased across time-points (p=0.007).


Antiretroviral therapy improved mental health and QOL, irrespective of the treatment strategy.

Keywords: HIV infection, mental health, quality of life, treatment interruption..