AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #335 - Living well with HIV? Global evidence of high physical and psychological symptom burden in the presence of treatment
Authors: Presenting Author: Dr Richard Harding - Kings College London
Additional Authors:
Aim: HIV is now cast as a “chronic condition” where HIV treatments are available, and policy is shifting towards minimal monitoring of treatment response and an expectation of full functioning economically. However, a growing body of evidence suggests that, in addition to growing incidence of malignancies and organ failure, a high prevalence and associated burden exists of both physical and psychological symptoms. In this paper we aim to appraise original evidence on symptom prevalence and burden from Europe, Latin America and sub-Saharan Africa.
Method / Issue: In each study we have cross-sectionally applied the Memorial Symptom Assessment Scale Short Form, a measure of self-report 7-day period prevalence of 32 physical and psychological symptoms, in HIV adult outpatient settings.
Results / Comments: Data were collected in London UK (n=778), Buenos Aires (n=200), and Johannesburg (n=385). For all three sites the majority (67.4%, 79.1% and 98.4% respectively) were currently on ART. Although differences were found between samples, a very high prevalence was found for psychological symptoms . Sadness 59.1/64.7% in South Africa/Latin America and lack of energy 70.8% UK were the highest prevalence , but also problems of sexual dysfunction (52.0% and 53.5% in South African and UK respectively) and pain 51.2% and 53.2% in South Africa/London respectively. Importantly, CD4 count and ART use were not found to be associated with symptom burden, although an association was found for psychological burden and risk behaviour in UK.
Discussion: A high burden of disease, both physical and psychological, is reported by ambulatory HIV outpatient attendees. This burden persists alongside treatment. If the improvements in morbidity and mortality are to be matched with improved patient wellbeing, then existing clinical expertise in symptom assessment and control must be routinely applied.
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