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.