Symptom Experience in HIV-Infected Adults: A Function of Demographic and Clinical Characteristics

Abstract

Personal characteristics that interact with both HIV diagnosis and its medical management can influence symptom experience. Little is known about how symptoms in chronic illness populations vary by age, sex, or socioeconomic factors. As part of an ongoing prospective longitudinal study, this study describes symptoms experienced by 317 men and women living with HIV/AIDS. Participants were recruited at HIV clinics and community sites in the San Francisco Bay area. Measures included their most recent CD 4 cell count and viral load from the medical record, demographic and treatment variables, and the 32-item Memorial Symptom Assessment Scale to estimate prevalence, severity, and distress of each symptom as well as global symptom burden. The median number of symptoms was nine, and symptoms experienced by over half the sample included lack of energy (65%), feeling drowsy (57%), difficulty sleeping (56%), and pain (55%). Global symptom burden was unrelated to age or CD 4 cell count. Those with an AIDS diagnosis had significantly higher symptom burden scores, as did those currently receiving anti-retroviral (ART) therapy. African Americans reported fewer symptoms than Caucasians or Mixed/Other race and women reported more symptom burden after controlling for AIDS diagnosis and race. Since high symptom burden is more likely to precipitate self-care strategies that may potentially be ineffective, strategies for symptom management would be better guided by tailored interventions from health care providers. KeywordsHIV; gender; sex; transgender; ethnicity; race; symptoms; sleep; fatigue; pain The tragedy of HIV infection is that it most often strikes young adults between 25-39 years of age, the time of greatest potential for productive vocations or careers (1,2). With better therapies, adults with HIV/AIDS are living longer, and health care providers are shifting to a chronic illness model to better manage symptoms associated with HIV infection and treatment. COPYEDITOR: DO NOT EXPAND HIV or AIDSPublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Previous research on the symptom experience of adults living with HIV/AIDS has been devoted to characterizing the prevalence of various symptoms, with some attention to side effects of therapy (3) or extent of the disease process (4,5). Yet there has been little contrast by gender or social roles and socioeconomic factors that could influence symptom burden experienced within the same disease population. NIH Public AccessEpidemiological data from surveys of the general population indicate that women experience more symptoms than men (6)...

Types of Sleep Problems in Adults Living with HIV/AIDS

“…The symptom experience of this sample was previously reported in more detail. 10 In addition to the MSAS "lack of energy" item, the sleep diary described above asked 4 specific items that were descriptors of fatigue (tired, sleepy, drowsy, fatigued) on a scale of 0 (not at all) to 10 (extremely) in the evening before bedtime and in the morning upon awakening. These items were derived from the 18-item Lee Fatigue Scale.…”

“…Sleep disturbance is not only prevalent, but also one of the more intense and distressful symptoms experienced in this population. [8][9][10] In HIV infection, poor sleep has been associated with disease progression, medication therapy, employment status, and lack of knowledge about behaviors that promote good sleep. [11][12][13][14] The specifi c type of sleep disturbance experienced by this population needs to be better understood in order to provide the most effective intervention to improve symptoms, daytime functioning, and quality of life.…”

Behavioral Surveillance Study: Sexual Risk Taking Behaviour in UK HIV Outpatient Attendees

“…Evidence suggests that a high psychological and physical symptom burden persists among HIV-diagnosed individuals despite new treatments [11][12][13][14], and that patient-reported symptoms and health-related quality of life may be important predictors of clinical and virological outcomes [15,16] but few studies have assessed the association of symptoms and quality of life with sexual risk behaviour.…”

Qualitative Investigation of a Brief Chronic Pain Screening Tool in HIV-Infected Patients

“…17 Most studies of chronic pain prevalence in HIV-infected patients rely on queries pertaining to short time frames (1 day to 1 month), [5][6][7][8][9][10][11][12][13] or methods of screening for chronic pain that have not been validated in any clinical population. 13 Furthermore, well-validated pain questionnaires, such as the Brief Pain Inventory 18 and Multidimensional Pain Inventory, 19 have been used to study pain in patients with HIV, [5][6][7][8][9][10][11][12][13] but are not designed as screeners. As detailed questionnaires, they were designed to understand pain's impact on physical and emotional function in patients already known to have a pain condition, whether acute or chronic.…”