January 14, 2011
Noting the scarcity of data on the prevalence and burden of pain and symptoms among HIV patients in the era of antiretroviral therapy (ART), the authors set out to measure symptom prevalence and determine associations with key variables: demographics, treatment status, adherence, and risk behaviors.
In five HIV outpatient clinics in London and the southeast region of the United Kingdom, researchers administered a cross-sectional self-completed questionnaire. The subjects were consecutive patients who accepted the invitation to participate by responding to clinical and behavioral variables including the memorial symptom assessment schedule (short form). Four multivariable models were used to examine the relationship between dependent variables of psychological, physical, global symptom burden scores, number of symptoms, and key independent variables. A total of 778 patients, 77 percent of those approached, took part in the research.
Physical and psychological symptoms were "highly prevalent" among respondents, the authors found. In the preceding seven days, the proportion of patients experiencing particular symptoms was as follows: lack of energy, 70.8 percent; worry, 69.9 percent; diarrhea, 53.6 percent; sexual dysfunction, 53.5 percent; and pain, 53.2 percent. Multivariable analysis found unprotected sexual intercourse with a partner of unknown HIV status and poorer adherence to ART were significantly and independently associated with psychological symptom burden. A significant association was noted between lower educational achievement and increasing physical, psychological, and global symptom burden, and a higher number of symptoms. Taking ART was not found to be associated with any symptom distress measure.
"In the era of treatment, patients continue to experience high prevalence and burden of psychological and physical symptoms, which are not associated with treatment status," the authors concluded. "Attention to these distressing problems is essential and may enhance quality of life and adherence, and minimize risk behavior. Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse."