Improvements in Physical Wellbeing Over the First Two Years on Antiretroviral Therapy in Western Kenya

While improvements in physical wellbeing during the first six months of antiretroviral therapy (ART) are well documented, little is known regarding long-term follow-up. The authors conducted a prospective cohort study to assess wellbeing during the first two years on ART among 222 HIV-positive adult tea plantation workers in western Kenya.

During repeat ART clinic visits, the subjects completed a standardized questionnaire. Using a 30-day recall period, participants were asked the number of days when their health was poor and the number of days when pain made their usual activities at work and home difficult to accomplish. Using a seven-day recall period, subjects were asked to assess the severity of body pain, nausea, fatigue, and rash.

"Prevalence of most symptoms declined over time," the authors wrote. The median number of days of poor health declined from seven in the first month on ART to three in the 24th month (p=0.043). The number of days during which pain made activities difficult declined from a median of seven during the first month on ART to zero by 12 months (p less than or equal to 0.0001) but increased to three days by two years.

Through the two years, reports of any body pain (range 59-83 percent) and fatigue (51-84 percent) over the previous seven days were common. Reports of pain and fatigue often in the past seven days, however, declined during the two-year period (from 24-10 percent [p=0.067] and 41-15 percent [p=0.002]). Though reports of skin rash were rare, they were higher at two years (8.6 percent) than any other time during the study.

"Initial improvements in physical wellbeing were sustained over two years; however, increased pain and skin rash at year two may indicate problems as treatment programs mature," the authors concluded. "These improvements in physical wellbeing will be important in sustaining the long-term success of HIV treatment programs."

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