The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study
Identifieur interne : 004397 ( Ncbi/Merge ); précédent : 004396; suivant : 004398The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study
Auteurs : Katie Wakeham [Ouganda, Royaume-Uni] ; Richard Harding [Royaume-Uni] ; Jonathan Levin [Ouganda, Afrique du Sud] ; Rosalind Parkes-Ratanshi [Ouganda] ; Anatoli Kamali [Ouganda] ; David G. Lalloo [Royaume-Uni]Source :
- BMC Palliative Care [ 1472-684X ] ; 2017.
Abstract
Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.
HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures.
During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more.
Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes.
CRYPTOPRO [ISRCTN
The online version of this article (doi:10.1186/s12904-017-0215-y) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12904-017-0215-y
PubMed: 28705181
PubMed Central: 5508714
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p id="Par1">Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more.</p>
</sec>
<sec><title>Conclusion</title>
<p id="Par4">Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes.</p>
</sec>
<sec><title>Trial registration</title>
<p id="Par5">CRYPTOPRO [ISRCTN <ext-link ext-link-type="uri" xlink:href="https://www.isrctn.com/ISRCTN76481529?q=76481529&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search">76481529</ext-link>
], November 2004.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12904-017-0215-y) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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Liverpool, UK</nlm:aff>
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<author><name sortKey="Levin, Jonathan" sort="Levin, Jonathan" uniqKey="Levin J" first="Jonathan" last="Levin">Jonathan Levin</name>
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Entebbe, Uganda</nlm:aff>
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<institution>University of Witwatersrand,</institution>
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Johannesburg, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Johannesburg</wicri:regionArea>
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</author>
<author><name sortKey="Parkes Ratanshi, Rosalind" sort="Parkes Ratanshi, Rosalind" uniqKey="Parkes Ratanshi R" first="Rosalind" last="Parkes-Ratanshi">Rosalind Parkes-Ratanshi</name>
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<author><name sortKey="Kamali, Anatoli" sort="Kamali, Anatoli" uniqKey="Kamali A" first="Anatoli" last="Kamali">Anatoli Kamali</name>
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</author>
<author><name sortKey="Lalloo, David G" sort="Lalloo, David G" uniqKey="Lalloo D" first="David G" last="Lalloo">David G. Lalloo</name>
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<institution-id institution-id-type="GRID">grid.48004.38</institution-id>
<institution></institution>
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Liverpool, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liverpool</wicri:regionArea>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study</title>
<author><name sortKey="Wakeham, Katie" sort="Wakeham, Katie" uniqKey="Wakeham K" first="Katie" last="Wakeham">Katie Wakeham</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1790 6116</institution-id>
<institution-id institution-id-type="GRID">grid.415861.f</institution-id>
<institution></institution>
<institution>MRC/UVRI Uganda Research Unit on AIDS,</institution>
</institution-wrap>
Entebbe, Uganda</nlm:aff>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>Entebbe</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 9764</institution-id>
<institution-id institution-id-type="GRID">grid.48004.38</institution-id>
<institution></institution>
<institution>Liverpool School of Tropical Medicine,</institution>
</institution-wrap>
Liverpool, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liverpool</wicri:regionArea>
</affiliation>
<affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.410725.5</institution-id>
<institution>Sussex Cancer Centre,</institution>
<institution>Brighton and Sussex University Hospital,</institution>
</institution-wrap>
Eastern Road, Brighton, BN2 5DA UK</nlm:aff>
<wicri:noCountry code="subfield">BN2 5DA UK</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Harding, Richard" sort="Harding, Richard" uniqKey="Harding R" first="Richard" last="Harding">Richard Harding</name>
<affiliation wicri:level="1"><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2322 6764</institution-id>
<institution-id institution-id-type="GRID">grid.13097.3c</institution-id>
<institution>Department of Palliative Care, Policy & Rehabilitation,</institution>
<institution>King’s College London, Cicely Saunders Institute,</institution>
</institution-wrap>
London, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>London</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Levin, Jonathan" sort="Levin, Jonathan" uniqKey="Levin J" first="Jonathan" last="Levin">Jonathan Levin</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1790 6116</institution-id>
<institution-id institution-id-type="GRID">grid.415861.f</institution-id>
<institution></institution>
<institution>MRC/UVRI Uganda Research Unit on AIDS,</institution>
</institution-wrap>
Entebbe, Uganda</nlm:aff>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>Entebbe</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 1135</institution-id>
<institution-id institution-id-type="GRID">grid.11951.3d</institution-id>
<institution>School of Public Health, Faculty of Health Sciences,</institution>
<institution>University of Witwatersrand,</institution>
</institution-wrap>
Johannesburg, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Johannesburg</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Parkes Ratanshi, Rosalind" sort="Parkes Ratanshi, Rosalind" uniqKey="Parkes Ratanshi R" first="Rosalind" last="Parkes-Ratanshi">Rosalind Parkes-Ratanshi</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1790 6116</institution-id>
<institution-id institution-id-type="GRID">grid.415861.f</institution-id>
<institution></institution>
<institution>MRC/UVRI Uganda Research Unit on AIDS,</institution>
</institution-wrap>
Entebbe, Uganda</nlm:aff>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>Entebbe</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Kamali, Anatoli" sort="Kamali, Anatoli" uniqKey="Kamali A" first="Anatoli" last="Kamali">Anatoli Kamali</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1790 6116</institution-id>
<institution-id institution-id-type="GRID">grid.415861.f</institution-id>
<institution></institution>
<institution>MRC/UVRI Uganda Research Unit on AIDS,</institution>
</institution-wrap>
Entebbe, Uganda</nlm:aff>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>Entebbe</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Lalloo, David G" sort="Lalloo, David G" uniqKey="Lalloo D" first="David G" last="Lalloo">David G. Lalloo</name>
<affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 9764</institution-id>
<institution-id institution-id-type="GRID">grid.48004.38</institution-id>
<institution></institution>
<institution>Liverpool School of Tropical Medicine,</institution>
</institution-wrap>
Liverpool, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liverpool</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series><title level="j">BMC Palliative Care</title>
<idno type="eISSN">1472-684X</idno>
<imprint><date when="2017">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p id="Par1">Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more.</p>
</sec>
<sec><title>Conclusion</title>
<p id="Par4">Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes.</p>
</sec>
<sec><title>Trial registration</title>
<p id="Par5">CRYPTOPRO [ISRCTN <ext-link ext-link-type="uri" xlink:href="https://www.isrctn.com/ISRCTN76481529?q=76481529&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search">76481529</ext-link>
], November 2004.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12904-017-0215-y) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<pubmed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study.</title>
<author><name sortKey="Wakeham, Katie" sort="Wakeham, Katie" uniqKey="Wakeham K" first="Katie" last="Wakeham">Katie Wakeham</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. katiewakeham@nhs.net.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Harding, Richard" sort="Harding, Richard" uniqKey="Harding R" first="Richard" last="Harding">Richard Harding</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Levin, Jonathan" sort="Levin, Jonathan" uniqKey="Levin J" first="Jonathan" last="Levin">Jonathan Levin</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Parkes Ratanshi, Rosalind" sort="Parkes Ratanshi, Rosalind" uniqKey="Parkes Ratanshi R" first="Rosalind" last="Parkes-Ratanshi">Rosalind Parkes-Ratanshi</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kamali, Anatoli" sort="Kamali, Anatoli" uniqKey="Kamali A" first="Anatoli" last="Kamali">Anatoli Kamali</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lalloo, David G" sort="Lalloo, David G" uniqKey="Lalloo D" first="David G" last="Lalloo">David G. Lalloo</name>
<affiliation wicri:level="1"><nlm:affiliation>Liverpool School of Tropical Medicine, Liverpool, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liverpool School of Tropical Medicine, Liverpool</wicri:regionArea>
<wicri:noRegion>Liverpool</wicri:noRegion>
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</author>
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<publicationStmt><idno type="wicri:source">PubMed</idno>
<date when="2017">2017</date>
<idno type="RBID">pubmed:28705181</idno>
<idno type="pmid">28705181</idno>
<idno type="doi">10.1186/s12904-017-0215-y</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study.</title>
<author><name sortKey="Wakeham, Katie" sort="Wakeham, Katie" uniqKey="Wakeham K" first="Katie" last="Wakeham">Katie Wakeham</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. katiewakeham@nhs.net.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Harding, Richard" sort="Harding, Richard" uniqKey="Harding R" first="Richard" last="Harding">Richard Harding</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Levin, Jonathan" sort="Levin, Jonathan" uniqKey="Levin J" first="Jonathan" last="Levin">Jonathan Levin</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Parkes Ratanshi, Rosalind" sort="Parkes Ratanshi, Rosalind" uniqKey="Parkes Ratanshi R" first="Rosalind" last="Parkes-Ratanshi">Rosalind Parkes-Ratanshi</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kamali, Anatoli" sort="Kamali, Anatoli" uniqKey="Kamali A" first="Anatoli" last="Kamali">Anatoli Kamali</name>
<affiliation wicri:level="1"><nlm:affiliation>MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.</nlm:affiliation>
<country xml:lang="fr">Ouganda</country>
<wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea>
<wicri:noRegion>Entebbe</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lalloo, David G" sort="Lalloo, David G" uniqKey="Lalloo D" first="David G" last="Lalloo">David G. Lalloo</name>
<affiliation wicri:level="1"><nlm:affiliation>Liverpool School of Tropical Medicine, Liverpool, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liverpool School of Tropical Medicine, Liverpool</wicri:regionArea>
<wicri:noRegion>Liverpool</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">BMC palliative care</title>
<idno type="eISSN">1472-684X</idno>
<imprint><date when="2017" type="published">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.</div>
</front>
</TEI>
</pubmed>
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