Original ArticleSymptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa
Introduction
The symptom management experience is a critical area in HIV/AIDS research (Chiou et al., 2004, Chiou et al., 2006, Hughes, 2004, Spirig et al., 2005). These symptoms can occur due to HIV disease, as secondary complications related to HIV comorbidities, or as side effects of antiretroviral therapy (ARV) and other medications. Recent literature suggests that many symptoms begin early in HIV disease and continue across the spectrum of infection (Holzemer, 2002), and numerous studies suggest that a variety of symptoms occur across the trajectory of HIV disease (Bakken et al., 2000, Portillo et al., 2007, Sukati et al., 2005, Tsai et al., 2002). Symptoms related to HIV disease and the complex symptom experience that occurs due to ARV are the focus of this study.
In our review, studies and meta-analyses suggest that symptoms may be linked to adherence to antiretroviral medications in HIV disease (Mellins et al., 2008, Mills et al., 2006). Health care providers have identified concerns that symptoms from HIV disease and medication-related symptoms may diminish antiretroviral (ARV) adherence (Liechty & Bangsberg, 2003). In a recent meta-analysis, however, Mills et al. (2006) suggested that adherence to ARVs in sub-Saharan Africa is greater than in North America. Because HIV-infected persons in South Africa may experience a variety of symptoms due to HIV infection, comorbidities, side effects of medications, opportunistic infections, nutrition, and living circumstances, it is critical that the symptom management experience be examined in this population because the prevalence of HIV and disease burden is so high.
The purpose of this study was to examine sociodemographic characteristics, frequency of symptoms, health status, quality of life, and the impact of symptoms reported by those taking antiretroviral medications in KwaZulu-Natal, South Africa. Recent statistics from the Joint United Nations Programme on HIV/AIDS (UNAIDS, 2007) indicate that KwaZulu-Natal province is the epicenter of HIV infection in South Africa, with nearly 40% of the population living with HIV.
Section snippets
Overview of HIV-related symptoms
Symptoms experienced by those living with HIV/AIDS are numerous and may be related to HIV progression, comorbid disease, and side effects of medications.
In a sample of individuals living with HIV in southern Africa (Botswana, Lesotho, South Africa, Swaziland; n = 743), Sukati et al. (2005) reported on self-care strategies to manage HIV-related symptoms in a sample of HIV-infected persons. These participants identified 3 to 6 symptoms they experienced and self-care strategies, sources of
Methods
Using a cross-sectional, descriptive design, the sample was composed of 149 persons from four outpatient settings in Durban, South Africa. Fourteen symptoms were rated (1–10) by intensity and the effect of symptoms on activity levels. Medication adherence was measured by the AIDS Clinical Trial Group (ACTG) Adherence scale. Demographic and symptom-related variables were examined. Pearson correlation coefficients and logistic regression analyses were computed.
Demographic characteristics
Most of the respondents in the study were women (n = 95, 64.0%), of Zulu background (n = 143, 96%), have an educational level of 12th grade or less (n = 99, 67.3%), were unemployed (n = 86, 58%), and were experiencing at least three symptoms related to HIV/AIDS and/or medications. Mean age of the sample was 35.5 years (SD = 7.5, range = 21–61 years) with no significant differences in age found between men and women. More than one third of the participants were married (n = 50, 33.5%); 36.9% (n
Discussion
The study adds to the body of knowledge on the most frequent symptoms reported in KwaZulu-Natal and that adherence remains high despite symptoms that occur due to HIV disease, comorbid health problems, or related to ARV medications. In our study, participants experienced numerous symptoms with fatigue, rashes, headaches, insomnia, sadness, disturbing dreams, numbness, pain, and self-appearance as the most commonly experienced symptoms. Regarding the most frequently reported symptoms, it is
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