MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
Liverpool School of Tropical Medicine, Liverpool, UK.
BMC Palliat Care. 2017 Jul 13;17(1):8. doi: 10.1186/s12904-017-0215-y.
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 76481529 ], November 2004.
在整个疾病过程中，HIV 感染者普遍存在身体和心理症状。尽管未解决的疼痛和症状对临床和公共卫生具有重要影响，但对于抗逆转录病毒疗法 (ART) 对这些结果的影响知之甚少。本研究旨在评估乌干达 CD4 计数<200 个/μL 的个体在开始接受 ART 后一年内症状负担的变化。
从乌干达农村的自愿检测和咨询服务转介来参加一项随机对照试验，以测试氟康唑作为预防隐球菌病的初级预防药物的 HIV 感染、ART 初治的成年人，被邀请在开始接受 ART 之前和随后的两次随访中完成 Memorial Symptom Assessment Scale-Short Form (MSAS-SF)。该工具测量自我报告的 7 天期间患病率以及身体和心理症状的相关负担。通过拟合线性混合模型进行重复测量，研究了 ART 治疗时间和试验臂对总症状数量和困扰指数的变化。
在开始 ART 的第一年，大多数个体症状的患病率保持不变。开始接受 ART 后改善的显著例外情况如下：疼痛的患病率（从 79%降至 60%）、体重减轻（从 67%降至 31%）、食欲不振（从 46%降至 28%）、感到悲伤（从 52%降至 25%）和睡眠困难（从 35%降至 23%）。治疗开始后，总症状数和困扰指数减少。值得关注的是，半数或更多的研究参与者在开始 ART 后仍有疼痛（60%）、瘙痒（57%）、皮肤变化（53%）和手脚麻木（52%）的症状。仍有 16 种症状的负担在 25%或更高。
尽管 ART 具有降低症状的有益作用，但一些患者仍持续存在高症状负担。撒哈拉以南非洲的 HIV 服务必须将症状管理纳入其方案。
CRYPTOPRO [ISRCTN 76481529]，2004 年 11 月。
