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. 2011 Jul;42(1):12-23.
doi: 10.1016/j.jpainsymman.2010.09.021. Epub 2011 Mar 23.

Patterns of change in symptom clusters with HIV disease progression

Paul F Cook  1 , Karen H Sousa, Ellyn E Matthews, Paula M Meek, Jeffrey Kwong
Affiliations

Patterns of change in symptom clusters with HIV disease progression

Paul F Cook et al. J Pain Symptom Manage. 2011 Jul.

Abstract

Context: With better antiretroviral treatments (ARTs), persons living with HIV (PLWH) are living longer, healthier lives. Therefore, they also experience more medical comorbidities that come with normal aging, as well as side effects of multiple treatments and long-term sequelae of HIV. It can be hard to know whether symptoms reported by PLWH are related to comorbidities or are signs of HIV disease progression and possible treatment failure.

Objectives: The current study was designed to disentangle these issues by examining within-person symptom changes in data collected from a cohort of PLWH before the advent of highly efficacious ART.

Methods: This study was a secondary analysis of symptom reports in longitudinal data collected from 246 PLWH in 1992-1994. Multilevel modeling was used to test for changes over time in HIV-related symptom clusters. Analyses also tested the effects of person-level demographic covariates and co-occurring mental health symptoms on HIV symptoms and examined the magnitude of within-person versus between-person variations in reported symptom severity.

Results: Two of six HIV-related symptom clusters, malaise/fatigue and nausea/vomiting, increased over time in the context of HIV disease progression, but the other four did not. Changes were independent of baseline disease severity or psychological covariates. There was substantial within-person variability in absolute symptom severity.

Conclusion: Relatively small but consistent changes in symptoms related to nausea or fatigue may suggest HIV disease progression, but changes in other HIV symptom clusters may instead be related to comorbidities or normal aging. Further research is recommended on symptom progression in PLWH.

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Conflict of interest statement

Disclosures

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Change in Malaise/Fatigue with HIV Disease Progression
Note. Lines represent fitted regression models for individual participants’ symptom changes over time, with time entered as an uncentered level-1 predictor of malaise/fatigue, and using a random-slopes and random-intercepts approach with participants’ baseline CD4 values as a level-2 predictor. Differences in the y-intercept for each line represent between-person variability in the overall severity of symptom reports. The positive slope of each line show within-person increases in symptom severity over time.
Figure 2
Figure 2. Change in Nausea/Vomiting with HIV Disease Progression
See this image and copyright information in PMC

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