Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse
- Richard Harding1,
- Fiona C Lampe2,
- Sally Norwood2,
- Heather Leake Date3,
- Claudine Clucas2,
- Martin Fisher3,4,
- Margaret Johnson5,
- Simon Edwards6,
- Jane Anderson7,
- Lorraine Sherr2
- 1King's College London, School of Medicine at Guy's, King's and St Thomas' Hospitals, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, UK
- 2Department of Primary Care and Population Sciences, Royal Free University College Medical School, London, UK
- 3Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- 4Royal Free University College Medical School, London, UK
- 5Royal Free Centre for HIV Medicine, London, UK
- 6Department of Genitourinary Medicine, Mortimer Market Centre, Camden PCT, London, UK
- 7Homerton University Hospital NHS Foundation Trust, London, UK
- Correspondence to Dr Richard Harding, King's College London, School of Medicine at Guy's, King's and St Thomas' Hospitals, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London SE5 9PJ, UK;
Contributors LS and RH designed the study and were involved at all stages; HLD, MF, MJ, SE and JA commented on the design and participated in data collection and write up; FCL is the study statistician; SN and CL were the study research assistants and coordinated data collection and data handling.
- Accepted 29 March 2010
- Published Online First 15 June 2010
Objectives There is a paucity of data reporting the prevalence and burden of pain and symptoms among HIV patients in the era of antiretroviral therapy (ART). This study aimed to measure symptom prevalence and determine associations with key variables: demographics, treatment status, adherence and risk behaviours.
Design Cross-sectional self-completion questionnaire in five HIV outpatient clinics in London and the south east UK.
Methods Consecutive patients were invited to participate, responding to clinical and behavioural variables including the memorial symptom assessment schedule (short form). Four multivariable models examined the relationship between dependent variables of psychological, physical, global symptom burden scores, the number of symptoms and key independent variables. 778 patients participated; response rate 77% of all patients approached.
Results Both physical and psychological symptoms were highly prevalent: in the previous 7 days, 70.8% experienced lack of energy, 69.9% worry, 53.6% diarrhoea, 53.5% sexual dysfunction and 53.2% pain. In multivariable analysis, both unprotected sexual intercourse with a partner of unknown status, and poorer ART treatment adherence were significantly and independently associated with psychological symptom burden. Lower educational achievement was significantly associated with increasing physical, psychological and global symptom burden and with higher number of symptoms. Being on ART was not associated with any symptom distress measure.
Conclusions In the era of treatment, patients continue to experience high prevalence and burden of psychological and physical symptoms, which are not associated with treatment status. Attention to these distressing problems is essential and may enhance quality of life and adherence and minimise risk behaviour. Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse.
Funding This research was assisted with an unrestricted educational grant from GlaxoSmithKline, with input from the Adherence Strategy Group.
Competing interests None.
Ethics approval This study was conducted with the approval of the Royal Free Hospital University College Medical School Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.