Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa

Abstract

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60–8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

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.