Advances in HIV treatment have transformed it from incurable to a manageable disease, requiring continuous use of medication to suppress viral growth. However, as people living with HIV live longer, the risk of lifestyle diseases such as diabetes increases with age [1]. Additionally, previous studies have shown that stigma and discrimination remain prevalent, potentially leading to psychological issues [2]. This has increased the demand for patient-centered medicine beyond viral suppression.

Patient-reported outcome (PROs) are gaining attention as tools for patient-centered care. PROs are based on patients’ direct responses to questionnaires. Their validity has been evaluated in various studies, and PROs can assess symptoms, functioning, health status, and quality of life (QOL) [3]. PROs can be disease-specific or general, applicable across conditions. Clinicians can select appropriate PROs for care and research.

PROs are increasingly used for diseases affecting long-term QOL, including malignancies. Studies have revealed gaps between patients and providers in assessing treatment side-effects. Patient-centered evaluations are crucial for improving health-related QOL (HRQOL) in cancer care [4]. In collagen diseases, PROs are used to evaluate symptoms like pain and improve care quality and HRQOL. Thus, PROs are valuable for enhancing care and supporting patient-centered medicine.

PROs have rarely been evaluated in infectious diseases, particularly acute infections, which often resolve with short-term treatment. We previously assessed PROs to measure QOL in patients with community-acquired influenza [5]. After antiviral treatment for influenza, mental QOL worsened during the course. Physical QOL was higher in vaccinated than in nonvaccinated patients [6]. These findings suggest PROs may benefit HIV care, as HIV has become a chronic disease.

In Europe and the United States, PROs are used in HIV trials to evaluate efficacy and adverse effects. Experts report that PROs improve HRQOL in people living with HIV when applied in practice. Recently, an electronic patient-reported outcome (ePRO) system was developed for real-time health assessment via tablets or computers in clinics. The European AIDS Clinical Society 2023 guidelines recommend this ePRO system [7]. In 2022, we collaborated with Integrity Healthcare Corporation and Gilead Sciences Inc. to develop a home-based mobile ePRO app. Here, we present a feasibility study of our prototype mobile ePRO app and its utility.

Twenty-seven patients used the mobile app in clinical practice. All patients were male, with a median age of 46 years. All were taking antiretroviral treatment, had maintained a CD4-positive lymphocyte count >200/μL for the past six months, and had a viral load <200 copies.

Twenty-five patients returned the postuse questionnaire. Nineteen of 25 (76%) respondents reported it took 5 minutes to complete; 5 (20%) reported 5-10 minutes, and one (4%) reported >15 minutes. Regarding satisfaction, 19 (76%) patients were very satisfied or satisfied, 5 (20%) were neutral, and one (4%) was somewhat dissatisfied. Nineteen (76%) patients found the questionnaire very or mostly useful for communication; 6 (24%) patients reported it to be neutral. Regarding future use, 19 (76%) patients wished to continue, 5 (20%) preferred use with improvements, and 1 did not.

Medical record review showed that 17/27 (63%) patients had additional information not recorded in the past two years. Of these, 7 (26%) reported mental health–related symptoms and 7 (26%) had skin problems. In 6 (22%) patients, PRO usage led to new treatments or actions not taken in the previous two years. Three patients were referred to dermatology, and 1 was newly diagnosed with chronic obstructive pulmonary disease following a complaint of respiratory symptoms.

Over 40% (n=11) patients reported symptoms including anxiety, sleep issues, rashes, dry or itchy skin, and appearance changes from weight or fat gain.

This study demonstrated the feasibility and clinical utility of a newly developed ePRO smartphone app for people living with HIV. The system was well accepted, with most users completing the questionnaire in under 5 minutes and reporting high satisfaction. The ePRO facilitated improved communication between patients and clinicians and led to documentation of new clinical information in nearly two-thirds of participants. These findings support the hypothesis that an ePRO system tailored for people living with HIV can enhance patient-centered care and identify unrecognized issues.

The short completion time and favorable user responses suggest that the app’s design featuring fewer questions and a simplified interface, contributed to its high acceptability. This aligns with studies emphasizing minimal patient burden when implementing PROs in chronic disease care [3]. The enhanced documentation of mental and dermatological symptoms highlights how ePROs can uncover patient concerns that may be under-reported during standard consultations. These findings align with literature showing PROs improve HRQOL by better capturing subjective symptoms [9].

Notably, mental health issues common among people living with HIV often go undiagnosed due to their subjective nature and limited psychiatric training among providers. Similarly, skin-related concerns such as rashes or appearance changes are frequently under-recognized in routine care. ePROs appear to bridge this gap by allowing patients to express symptoms that may not surface during clinician-led interviews. Compared to paper- or tablet-based PROs, smartphone apps offer greater accessibility and real-time symptom reporting from any location. As smartphone use increases globally, especially among younger generations, app-based ePROs hold promise for broader implementation in HIV care and beyond.

This study has limitations. First, the small sample from a single center may limit generalizability. Second, the retrospective design and lack of a control group prevent causal inference. Third, only the HIV symptom index was used; the utility of other PRO tools remains unexplored. While most participants expressed satisfaction, some suggested improvements, indicating room for optimization. Finally, the short observation period limits assessment of long-term utility and sustainability.

The findings of this study underscore the feasibility and clinical relevance of incorporating smartphone-based ePRO systems into HIV outpatient care. By enabling the identification of otherwise undocumented symptoms and improving communication between patients and providers, ePROs may contribute to more holistic and person-centered care models. These findings support the integration of digital health tools in HIV management and highlight the potential for ePROs to address unmet needs in clinical communication and symptom assessment. Future research should refine the app, broaden use, and evaluate long-term outcomes of routine ePRO implementation.