Symptom Burden in HIV-Infected Adults at Time of HIV Diagnosis in Rural Uganda

Purpose: This study aimed to measure symptom burden prior to antitetroviral therapy (ART) initiation in a population of adults with low CD4 presenting for human immunodeficiency virus (HIV) care and treatment in Uganda, and to explore the relationship between World Health Organization (WHO) stage, CD4 count, and symptomatology. Methods: HIV-infected, ART-naive adults with CD4 less than 200 cells per microliter referred from voluntary testing and counseling services in rural Uganda for potential enrollment into a large double-blinded placebo-controlled trial were invited to completed the Memorial Symptom Assessment Scale-Short Form (MSAS-SF). This is a validated symptom assessment tool that records the presence and severity of 37 physical and 4 psychological symptoms. Results: Two hundred twelve subjects were enrolled. The mean total number of symptoms was 14.0 (standard deviation [SD] = 6). The 10 most common symptoms were pain (76%), weight loss (70%), itching (67%), feeling drowsy/tired (61%), and lack of energy (61%), numbness = tingling in hands or feet (57%), cough (53%) skin changes (52%), worry (51%), and lack of appetite (49%). The median number of symptoms was not associated with WHO stage CD4 count group. Conclusion: This study demonstrates that the burden of HIV-related symptoms in individuals presenting for care in Uganda is significant and debilitating.