Physical and psychological symptoms are highly prevalent in
HIV-positive patients, investigators from the UK report in the online edition
of Sexually Transmitted Infections.
Unprotected sex with a partner of an unknown or different
HIV status and poor adherence to HIV treatment were both associated with a high
burden of psychological symptoms.
“The patient burden of disease remains high, and outcomes
are unlikely to be improved without careful attention to the patient experience
of disease and a clinical focus beyond virology”, comment the investigators.
From the time of seroconversion, HIV infection is associated
with a high prevalence of distressing symptoms. The World Health Organization
recommends that interventions to control pain and symptoms should be an
essential part of HIV care.
However, research suggests that physicians often fail to
detect symptoms in their patients, and that many individuals with HIV are
living with untreated pain and other symptoms.
Investigators in London and south-east England were
concerned about this lack of attention to symptoms. They also wished to see how
prevalent symptoms were in their patients and if experiencing symptoms was
associated with adherence to HIV treatment, unprotected sex, and disclosure of
HIV status to sex partners.
Therefore, in 2005-06 a total of 778 patients took part in a
cross-sectional study.
Study participants were asked to provide demographic
information and to say if they had experienced any of 26 physical or
psychological symptoms in the past seven days. The distress caused by symptoms
was scored on a scale of 0-4.
Information was also sought on the use of antiretroviral
therapy. Those taking HIV treatment were asked to report their level of
adherence in the previous week. All individuals were asked if they had had
unprotected sex with a partner who was HIV-negative or of unknown status in the
previous three months and if they disclosed their HIV status to partners.
Most (66%) of the participants were gay or bisexual men and
were white (67%). The mean age was 40 years. A little over half (51%) of
patients were born in the UK, and 45% had a degree.
Over two-thirds (67%) of patients were taking HIV therapy.
Complete adherence to treatment was reported by 42%; partial adherence by 36%;
and poor adherence by 22%. A third of patients taking treatment had switched
therapy once and 40% reported multiple treatment changes.
A total of 11% of patients reported unprotected sex in the
previous three months with a partner who may have been HIV-negative, and 6% had
never disclosed to a sex partner
Symptoms were highly prevalent. The mean number of reported
symptoms was 18. The mean symptom physical distress score was 0.81, the mean
psychological distress score was 1.34, and the global distress score was 1.16.
Lack of energy was reported by 71% of patients, tiredness by
68%, difficulty sleeping by 62%, poor concentration by 61%, worry by 70%,
sadness by 66%, diarrhoea by 54% and sexual problems by 53%.
Possession of a degree was associated with less symptom-related
physical (p = 0.004), emotional (p = 0.007) and overall (p = 0.021) distress.
In addition, white patients reported less symptom related
distress (p = 0.04) than those of other ethnicities. The investigators think
that this could be because many black African patients in the UK are diagnosed
late when they are ill because of HIV and therefore likely to be experiencing
symptoms.
Disclosure of HIV was significantly associated with fewer
symptoms (p = 0.021), and reporting unprotected sex with a partner who may have
been HIV-negative was associated with a greater number of psychological
symptoms (p = 0.047).
“Interestingly”, write the investigators, “currently being
on antiretroviral therapy was not significantly associated with any of the
symptom measures.”
Analysis was then restricted to the patients who were taking
HIV treatment. Poor adherence was significantly associated with psychological
(p = 0.001) and global distress (p = 0.006). Switching treatment was associated
with both physical (p = 0.003) and psychological distress (p = 0.006) caused by
symptoms, as well as a greater number of total symptoms (p = 0.013).
Being born in the UK and having a degree were both
associated with a lower burden of physical symptoms.
“The data…reveal high 7-day prevalence and associated
distress of burdensome symptoms”, comment the investigators, who conclude: “It
is essential that quality management of HIV disease routinely assess these
distressing problems, so that key outcomes of risk behaviour and adherence may
be optimally influenced.”