Abstract #292  -  Psychological and physical symptomatology in the era of treatment: Argentinean outpatients report high burden even after initiating treatment
Authors:   Presenting Author:   Dr Richard Harding - King's College London
Additional Authors:  Dr Jorge Eisenchlas, Dr Pedro Cahn, Dr R Strauss, Prof Lorraine Sherr, Dr Liliana DeLima,
Aim: Since the availability of ART, clinical research has largely ignored the symptom burden of HIV disease and treatment regimens, although they may be important aspects of maintaining acceptable quality of life with a long term condition. This study aimed to measure 7-day symptom prevalence among outpatients, and determine whether burden indices are associated with treatment status, CD4 count, viral load and risk behaviour.
Method / Issue: Cross-sectional questionnaire included MSAS-SF symptom checklist. 3 linear regression models were run with Global, Physical, and Psychological symptom burden indices as independent variable for each. Within each univariate model, independent variables were treatment status, CD4 count and viral load. Chi-square compared treatment status with sexual risk behaviour. Multivariate models were run entering any variable sig at 25% level in univariate analysis. The study was conducted in a large public outpatient clinic in Buenos Aires Argentina.
Results / Comments: Sample=200 (response rate 67%), 55% heterosexual, 45% homo/bisexual. 62.4% were male, 31% female, 6.6% transgendered. Mean CD4 was 440 (sd 245), 79.1% currently on ART, of whom 77.1% had viral load <50. Symptoms with highest 7-day prevalence were: feeling sad: 59.1%, feeling nervous: 56.3%, lack of energy: 53.5%, disturbed sleep 37.2%, numbness/tingling in hands/feet 34.5%, weight loss 30.2%. Mean number of symptoms was 8.5 (sd 5.9). There was no significant association between the independent variables of CD4 count, viral load, or treatment status and the 3 models’ dependent variable of global burden (p=0.384, p=0.198, p=0.074 respectively ) physical burden (p=0.557, p=0.504, p=0.299) or psychological burden (p=0.188, p=0.259, p=0.080). Mean number of symptoms did not differ between treated/untreated groups (p=0.638). Although no association was found between symptom burden indices and risk behaviour, those on treatment were more likely to report unprotected intercourse with a person of unknown status in the previous month (24% vs 13%, x2=5.28, p=0.022).
Discussion: These data offer important evidence for clinical assessment and management. Firstly, in the ART era, symptom prevalence remains high. Second, symptom prevalence and burden are not lessened by being on treatment, or by virological response. Third, those on treatment are more likely to report having unprotected sex. Adequate attention should be paid to symptomatology of both the treated and untreated, and to risk behaviours when treatment is initiated. This may enhance quality of life for those who respond to treatment and have greater life expectancy.
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