Harm of Symptoms Ignored
posted: 08/10/2010
Symptoms are common among people with HIV, and when they are ignored, as they often are by doctors, symptoms worsen people's taking of HIV treatment and lead to more risky sex.
Physical and psychological symptoms are highly common among people with HIV in the UK says a new report in the online issue of Sexually Transmitted Infections.
Physical and mental distress is high especially for people having unprotected sex with a partner of an unknown or different HIV status, and when people are struggling to take HIV treatments properly.
Symptoms unnoticed and untreated
From the moment of HIV infection, HIV is associated with a high rates of distressing symptoms. The World Health Organization recommends that controlling pain and symptoms should be an essential part of HIV care.
However, research suggests that doctors often do not detect the symptoms, and that many people with HIV have untreated pain and other symptoms.
How common are symptoms and what happens?
Investigators in London and south-east England were concerned that symptoms were being overlooked. They wanted to see how common symptoms were and if having symptoms was linked to differences in HIV treatment-taking, unprotected sex, and telling sex partners about HIV status.
So in 2005-06 778 patients took part in the study looking back at any symptoms over the last seven days.
Study participants were asked to provide basic information about themselves (age, gender etc) and to say if they had experienced any of 26 physical or psychological symptoms in the past seven days. The distress caused by symptoms was scored on a scale of 0-4. Those taking HIV treatment were asked to report their level of adherence in the previous week. All were asked if they had had unprotected sex with a partner who was HIV-negative or of unknown status in the previous three months, and if they disclosed their HIV status to partners.
Who are they?
Most (66%) of the people in this study were gay or bisexual men and were white (67%). The mean age was 40 years. A little over half (51%) of patients were born in the UK, and 45% had a degree.
Taking treatments – lots to improve
Over two-thirds (67%) of people were taking HIV treatments, and most people are not taking HIV treatments very well. Complete adherence to treatment was reported by 42%; partial adherence by 36%; and poor adherence by 22%. A third of people taking treatment had changed their HIV combination once and 40% reported multiple treatment changes.
Risky sex
A total of 11% of patients reported unprotected sex in the previous three months with a partner who may have been HIV-negative, and 6% had never disclosed to a sex partner
Symptoms all over
Symptoms were highly prevalent. The mean number of reported symptoms was 18. The mean symptom physical distress score was 0.81, the mean psychological distress score was 1.34, and the global distress score was 1.16.
Lack of energy was reported by 71% of patients, tiredness by 68%, difficulty sleeping by 62%, poor concentration by 61%, worry by 70%, sadness by 66%, diarrhoea by 54% and sexual problems by 53%.
Educated, white – less symptom harm
Having a university degree was associated with less symptom-related physical, emotional and overall distress.
In addition, white patients reported less symptom related distress than those of other ethnicities. The investigators think that this could be because many black African patients in the UK are diagnosed late when they are already ill and experiencing symptoms.
Telling others easier with few symptoms; more symptoms leads to risky sex
Disclosure of HIV was significantly associated with fewer symptoms, and reporting unprotected sex with a partner who may have been HIV-negative was associated with a greater number of psychological symptoms.
“Interestingly”, write the investigators, “currently being on antiretroviral therapy was not significantly associated with any of the symptom measures.”
Those on treatment
Then they looked at only the people taking HIV treatment. Poor adherence was significantly associated with psychological and global distress. Switching treatment was associated with both physical and psychological distress caused by symptoms, as well as a greater number of total symptoms.
Being born in the UK and having a degree were both associated with a lower burden of physical symptoms.
“The data…reveal high 7-day prevalence and associated distress of burdensome symptoms”, comment the investigators, who conclude: “It is essential that quality management of HIV disease routinely assess these distressing problems, so that key outcomes of risk behaviour and adherence may be optimally influenced.”
Source
Reference
Harding R et al. Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse. Sex Transm Infect, online edition, 2010 (click here for access to free abstract and paid-for full text).
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