Namisango Eve, Powell Richard A, Atuhaire Leonard, Katabira Elly T, Mwangi-Powell Faith, Harding Richard
1 African Palliative Care Association , Kampala, Uganda .
J Palliat Med. 2014 Mar;17(3):304-12. doi: 10.1089/jpm.2013.0291. Epub 2013 Dec 20.
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.
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.
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.
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.
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.
在感染艾滋病毒的人群中，症状困扰的描述较少，对身体和心理症状患病率的关注有限，难以据此提供最佳临床护理。
本研究的目的是测量艾滋病毒感染成年门诊患者七天内症状的患病率，并确定自我报告的症状负担是否与抗逆转录病毒疗法（ART）、CD4 T细胞计数和临床疾病阶段相关。
从乌干达两家转诊和教学医院的艾滋病毒门诊连续招募成年患者。在343名被邀请的患者中，302名（88%）参与了研究。患者使用纪念症状评估量表简表描述前一周的症状，并在访谈当天使用卡诺夫斯基功能状态（KPS）工具评估身体功能水平。
报告的症状负担较高，最常见的是担忧（94%）、悲伤（92%）、饥饿（82%）、紧张（75%）和困倦/疲惫（62%）。KPS评分<70的患者报告的症状更多（23种对10种；F=289.68，P<0.001），症状困扰程度更高（所有分析中P<0.04）。ART和CD4 T细胞计数均与症状负担无关。世界卫生组织临床分期4与心理症状负担相关（OR 2.94，P=0.011，CI 1.281-6.735）。男性更有可能经历更高的症状负担。
在抗逆转录病毒疗法时代，艾滋病毒/艾滋病门诊患者仍然承受着较高的身体和心理症状负担。对于患有晚期疾病的患者，心理症状尤为重要。在艾滋病毒门诊护理环境中，注意症状困扰模式中的性别差异很重要。饥饿的高患病率值得关注，因为它可能会影响抗逆转录病毒疗法的启动和依从性。
