APIN Public Health Initiatives, Abuja, Nigeria.
Northwestern University Feinberg School of Medicine, Center for Health Services & Outcomes Research, Chicago, IL, USA.
J Int Assoc Provid AIDS Care. 2020 Jan-Dec;19:2325958220903575. doi: 10.1177/2325958220903575.
Symptom management is an important component of HIV care. But symptom patterns and how they affect engagement with HIV care and treatment services have not been adequately explored in the era of increased HIV treatment scale-up. We investigated the relationship between symptom patterns among people living with HIV (PLHIV) and 12 months retention in care, within the context of other clinical and demographic characteristics.
Retrospective cohort analysis of 5114 PLHIV receiving care within a large HIV treatment program in Nigeria. We assessed the prevalence and burden of baseline symptoms reported during routine clinic visits from January 2015 to December 2017. Multivariable regression was used to identify relationships between 12-month retention and symptom dimensions (prevalence and burden) while controlling for demographic and other clinical variables.
Increasing symptom burden was associated with higher likelihood of retention at 12 months (adjusted odds ratio [aOR] = 1.19 [95% confidence interval, CI: 1.09-1.29]; < .001) as was the reporting of skin rashes/itching symptom (aOR = 2.59 [95% CI: 1.65-4.09]; < .001). Likelihood of retention reduced with increasing World Health Organization (WHO) Clinical staging, with CD4 ≥500 cells/mL and self-reported heterosexual mode of HIV transmission. : Symptom dimensions and standardized clinical/immunological measures both predicted retention in care, but effects differed in magnitude and direction. Standardized clinical/immunological measures in HIV care (eg, WHO clinical staging and CD4 count categories) can mask important differences in how PLHIVs experience symptoms and, therefore, their engagement with HIV care and treatment. Symptom management strategies are required alongside antiretroviral treatment to improve outcomes among PLHIV, including retention in care.
症状管理是 HIV 护理的重要组成部分。但在 HIV 治疗规模扩大的时代，症状模式及其对 HIV 护理和治疗服务参与的影响尚未得到充分探索。我们调查了在尼日利亚一个大型 HIV 治疗项目中接受护理的 HIV 感染者（PLHIV）的症状模式与 12 个月内保持护理的关系，同时考虑了其他临床和人口统计学特征。
对 2015 年 1 月至 2017 年 12 月期间在一个大型 HIV 治疗项目中接受护理的 5114 名 PLHIV 进行回顾性队列分析。我们评估了在常规就诊期间报告的基线症状的流行率和负担。使用多变量回归来确定 12 个月内保留与症状维度（流行率和负担）之间的关系，同时控制人口统计学和其他临床变量。
随着症状负担的增加，12 个月时保留的可能性更高（调整后的优势比 [aOR] = 1.19 [95%置信区间，CI：1.09-1.29]；<0.001），报告皮疹/瘙痒症状（aOR = 2.59 [95%CI：1.65-4.09]；<0.001）也是如此。保留的可能性随着世界卫生组织（WHO）临床分期的增加而降低，CD4≥500 个细胞/毫升和自我报告的异性恋 HIV 传播模式也是如此。
症状维度和标准化临床/免疫测量都预测了护理保留，但效果在大小和方向上有所不同。HIV 护理中的标准化临床/免疫测量（例如，WHO 临床分期和 CD4 计数类别）可能掩盖了 PLHIV 体验症状的重要差异，因此也掩盖了他们对 HIV 护理和治疗的参与。需要结合抗逆转录病毒治疗来管理症状，以改善 PLHIV 的结局，包括保留在护理中。
