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Randomized Controlled Trial
. 2017 Jul 13;17(1):8.
doi: 10.1186/s12904-017-0215-y.

The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study

Katie Wakeham  1   2   3 , Richard Harding  4 , Jonathan Levin  5   6 , Rosalind Parkes-Ratanshi  5 , Anatoli Kamali  5 , David G Lalloo  7
Affiliations
Randomized Controlled Trial

The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study

Katie Wakeham et al. BMC Palliat Care. .

Erratum in

  • Erratum to: BMC Palliative Care, Vol. 17.
    Pilot and Feasibility Studies. Pilot and Feasibility Studies. BMC Palliat Care. 2017 Oct 10;16(1):51. doi: 10.1186/s12904-017-0233-9. BMC Palliat Care. 2017. PMID: 29017489 Free PMC article. No abstract available.

Abstract

Background: Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.

Methods: HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures.

Results: During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more.

Conclusion: Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes.

Trial registration: CRYPTOPRO [ISRCTN 76481529 ], November 2004.

Keywords: ART; Africa; HIV; Pain; Palliative care; Symptom burden; Symptom control.

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Conflict of interest statement

Ethics approval and consent to participate

This study received ethical approval from the Uganda Virus Research Institute and Uganda National Council for Science and Technology. Written informed consent was obtained from all particpants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Observed values and fitted curves using a linear mixed model with study participants regarded as having random effects for total number of symptoms (panel a), Global Distress Index (panel b), Physical Symptom Distress Score (panel c) and Psychological Symptom Distress Score (panel d)
See this image and copyright information in PMC

References

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    1. Wakeham K, Harding R, Bamukama-Namakoola D, Levin J, Kissa J, Parkes-Ratanshi R, Muzaaya G, Grosskurth H, Lalloo DG. Symptom burden in HIV-infected adults at time of HIV diagnosis in rural Uganda. J Palliat Med. 2010;13(4):375–380. doi: 10.1089/jpm.2009.0259. - DOI - PubMed
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