Abstract #191  -  The symptom prevalence and burden in treatment naive immunosupressed HIV-1 infected adults in rural Uganda
Authors:   Presenting Author:   Dr Katie Wakeham - Univeristy of York/MRC Uganda unit
Additional Authors:
Aim: Data on the burden of physical and psychological symptoms in HIV infected Africans are scarce. We studied this both prior to and in the early weeks of antiretroviral therapy (ART).
Method / Issue: Symptom burden study participants were recruited in an unselected manner from November 2007 to January 2008 3 days per week during the enrolment visit for a large MRC funded trial,CRYPTOPRO. The study was conducted in Masaka, a rural district in South Western Uganda. Potential participants were recruited via voluntary testing and counseling (VCT) sessions from local HIV/AIDS care and support organisations. All participants were screened for CRYPTOPRO eligibility through clinical and laboratory assessments. Study subjects were consenting ART naive adults, with laboratory confirmation of HIV infection, a CD4 count less than 200 cells /uL and a negative Cryptococcal Antigen (CrAg) test. Exclusion criteria were pregnancy or lactation, liver function tests (LFT) > 3 x upper limit of normal (ULN) and terminal illness. All were considered by the study team to be fit to travel to the clinic take tablets and commence ART. Individuals were invited to complete the Memorial Symptom Assessment Scale Short Form (MSAS-SF)1 with a trained counselor . The MSAS-SF was translated and back translated into local dialects and discussed with clients in the language of their choice. This is a validated symptom assessment tool which records the presence and severity of 37 physical and 4 psychological symptoms. The mean burden scores of a set of symptoms are combined to produce the physical distress score (PHY), the psychological distress score (PSC) and the global distress index (GDI).
Results / Comments: 212 subjects were enrolled. 59% were female. The median age was 34 years (IQR 29-39) and median CD4 count 113 cells/ěl (IQR 52-156). At enrolment 69% were WHO clinical stage 3 or 4. The most common symptoms at enrolment were pain (77%), weight loss (71%), itching (67%), feeling tired (62%), lack of energy (61%), numbness/tingling in hands or feet (57%), and cough (54%). The frequency of worry, sadness and nervousness was 51%, 47% and 26% respectively. The mean number of symptoms at enrolment was 14.2 (s.d. 6.7). For GDI the independent predictors are WHO stage (the GDI increase with increasing WHO stage) and BMI (the GDI decreases with increasing BMI). PHYS was independently associated with WHO stage (increasing with WHO stage). The negative association with CD4 count did not approach statistical significance. PSYCH distress was independently associated with sex (higher in females) and WHO stage (increasing with increasing WHO stage). The TOTSYM was independently associated with WHO stage (increasing with WHO stage but about 3.6 symptoms for every increase stage). The negative association with CD4 count was not significantly significant.
Discussion: This study shows that in advanced HIV-1 infection in individuals at initial contact with HIV/AIDS care providers in Uganda there is a high burden of symptoms. In sub Saharan African countries including Uganda there is a need for the integration of palliative care services into the diverse types of research, NGO and governmental clinics who provide HIV care and ART.
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