Is Symptom Burden Associated with Treatment Status and Disease Stage among Adult HIV Outpatients in East Africa?

Background: Symptom distress is poorly described in persons living with HIV, with limited attention paid to physical and psychological symptom prevalence to inform optimal clinical care. Objectives: The study objective was to measure seven-day-period prevalence of symptoms among HIV-infected adult outpatients and determine if self-reported symptom burden is associated with antiretroviral therapy (ART), CD4 T-cell count, and clinical disease stage. Methods: Adult patients were consecutively recruited from HIV outpatient clinics at two referral and teaching hospitals in Uganda. Of 343 patients approached, 302 (88%) participated. Patients described symptoms during the previous week using the Memorial Symptom Assessment Scale Short Form, and level of physical functionality using the Karnofsky Performance Status (KPS) tool on the interview day. Results: A high symptom burden was reported, with the most prevalent being worry (94%), feeling sad (92%), hunger (82%), feeling nervous (75%), and feeling drowsy/tired (62%). Patients with KPS scores of < 70 reported more symptoms (23 versus 10; F = 289.68, P < 0.001) and higher symptom distress (P < 0.04 for all analyses). Neither ART nor CD4 T-cell count were associated with symptom burden. WHO clinical stage 4 was associated with psychological symptom burden (OR 2.94, P = 0.011, CI 1.281-6.735). Men were more likely to experience higher symptom burden. Conclusion: In the ART era, ambulatory HIV/AIDS patients continue to experience a high physical and psychological symptom burden. For those with advanced disease, psychological symptoms are particularly important. It is important to be observant of gender differences in patterns of symptom distress in HIV outpatient care settings. The high prevalence of hunger warrants attention as it may compromise ART initiation and adherence to ART.