The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study
Identifieur interne : 000662 ( Pmc/Curation ); précédent : 000661; suivant : 000663The 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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Katie Wakeham<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>Le document en format XML
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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><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Selwyn, Pa" uniqKey="Selwyn P">PA Selwyn</name></author><author><name sortKey="Rivard, M" uniqKey="Rivard M">M Rivard</name></author><author><name sortKey="Kappell, D" uniqKey="Kappell D">D Kappell</name></author><author><name sortKey="Goeren, B" uniqKey="Goeren B">B Goeren</name></author><author><name sortKey="Lafosse, H" uniqKey="Lafosse H">H LaFosse</name></author><author><name sortKey="Schwartz, C" uniqKey="Schwartz C">C Schwartz</name></author><author><name sortKey="Caraballo, R" uniqKey="Caraballo R">R Caraballo</name></author><author><name sortKey="Luciano, D" uniqKey="Luciano D">D Luciano</name></author><author><name sortKey="Post, Lf" uniqKey="Post L">LF Post</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harding, R" uniqKey="Harding R">R Harding</name></author><author><name sortKey="Molloy, T" uniqKey="Molloy T">T Molloy</name></author><author><name sortKey="Easterbrook, P" uniqKey="Easterbrook P">P Easterbrook</name></author><author><name sortKey="Frame, K" uniqKey="Frame K">K Frame</name></author><author><name sortKey="Higginson, Ij" uniqKey="Higginson I">IJ Higginson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wakeham, K" uniqKey="Wakeham K">K Wakeham</name></author><author><name sortKey="Harding, R" uniqKey="Harding R">R Harding</name></author><author><name sortKey="Bamukama Namakoola, D" uniqKey="Bamukama Namakoola D">D Bamukama-Namakoola</name></author><author><name sortKey="Levin, J" uniqKey="Levin J">J Levin</name></author><author><name sortKey="Kissa, J" uniqKey="Kissa J">J Kissa</name></author><author><name sortKey="Parkes Ratanshi, R" uniqKey="Parkes Ratanshi R">R Parkes-Ratanshi</name></author><author><name sortKey="Muzaaya, G" uniqKey="Muzaaya G">G Muzaaya</name></author><author><name sortKey="Grosskurth, H" uniqKey="Grosskurth H">H Grosskurth</name></author><author><name sortKey="Lalloo, Dg" uniqKey="Lalloo D">DG Lalloo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harding, R" uniqKey="Harding R">R Harding</name></author><author><name sortKey="Simms, V" uniqKey="Simms V">V Simms</name></author><author><name sortKey="Penfold, S" uniqKey="Penfold S">S 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sortKey="Higginson, Ij" uniqKey="Higginson I">IJ Higginson</name></author><author><name sortKey="Marconi, K" uniqKey="Marconi K">K Marconi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sherr, L" uniqKey="Sherr L">L Sherr</name></author><author><name sortKey="Lampe, F" uniqKey="Lampe F">F Lampe</name></author><author><name sortKey="Norwood, S" uniqKey="Norwood S">S Norwood</name></author><author><name sortKey="Leake Date, H" uniqKey="Leake Date H">H Leake Date</name></author><author><name sortKey="Harding, R" uniqKey="Harding R">R Harding</name></author><author><name sortKey="Johnson, M" uniqKey="Johnson M">M Johnson</name></author><author><name sortKey="Edwards, S" uniqKey="Edwards S">S Edwards</name></author><author><name sortKey="Fisher, M" uniqKey="Fisher M">M Fisher</name></author><author><name sortKey="Arthur, G" uniqKey="Arthur G">G Arthur</name></author><author><name sortKey="Zetler, S" uniqKey="Zetler S">S 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Palliat Care</journal-id><journal-id journal-id-type="iso-abbrev">BMC Palliat Care</journal-id><journal-title-group><journal-title>BMC Palliative Care</journal-title></journal-title-group><issn pub-type="epub">1472-684X</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28705181</article-id><article-id pub-id-type="pmc">5508714</article-id><article-id pub-id-type="publisher-id">215</article-id><article-id pub-id-type="doi">10.1186/s12904-017-0215-y</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Wakeham</surname><given-names>Katie</given-names></name><address><email>katiewakeham@nhs.net</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Harding</surname><given-names>Richard</given-names></name><address><email>Richardharding@kcl.ac.uk</email></address><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Levin</surname><given-names>Jonathan</given-names></name><address><email>Jonathan.Levin@mrcuganda.org</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Parkes-Ratanshi</surname><given-names>Rosalind</given-names></name><address><email>rp549@medschl.cam.ac.uk</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kamali</surname><given-names>Anatoli</given-names></name><address><email>Anatoli.Kamali@mrcuganda.org</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lalloo</surname><given-names>David G</given-names></name><address><email>David.Lalloo@lstmed.ac.uk</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><aff id="Aff1"><label>1</label><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</aff><aff id="Aff2"><label>2</label><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</aff><aff id="Aff3"><label>3</label><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</aff><aff id="Aff4"><label>4</label><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</aff><aff id="Aff5"><label>5</label><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</aff></contrib-group><pub-date pub-type="epub"><day>13</day><month>7</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>13</day><month>7</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2018</year></pub-date><volume>17</volume><elocation-id>8</elocation-id><history><date date-type="received"><day>28</day><month>11</month><year>2016</year></date><date date-type="accepted"><day>23</day><month>6</month><year>2017</year></date></history><permissions><copyright-statement>© The Author(s). 2017</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><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></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Symptom burden</kwd><kwd>Symptom control</kwd><kwd>Palliative care</kwd><kwd>HIV</kwd><kwd>Africa</kwd><kwd>ART</kwd><kwd>Pain</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/501100000265</institution-id><institution>Medical Research Council</institution></institution-wrap></funding-source></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2018</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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