Physical and Psychological Symptoms and Risk of Virologic Rebound Among Patients With Virologic Suppression on Antiretroviral Therapy

OBJECTIVE:We examined the association of self-reported physical and psychological symptoms with subsequent virologic rebound among patients with viral suppression on combination antiretroviral therapy (cART). METHODS:We included 188 HIV patients from a routine London clinic, who completed a questionnaire on heath/treatment issues in 2005, and were on cART, with viral load (VL) < 50 c/mL. Symptom measures were based on the Memorial Symptom Assessment Scale Short Form, and additional questions(1) physical symptom score; (2) psychological symptom score; (3) global symptom score; (4) total number of symptoms; (5) anxiety/depression; and (6) suicidal thoughts. Associations with time to (1) VL > 200 c/mL and (2) VL > 50 c/mL were assessed, considering each symptom measure separately. RESULTS:Of 188 patients, 22 experienced VL > 200 c/mL and 46 experienced VL > 50 c/mL (median follow-up2.2 years). Risk of VL > 200 c/mL was increased 4- to 5-fold for the highest versus lowest tertiles for the symptom scores (measures 1-3) and total number of symptoms (measure 4), and almost 4-fold for anxiety/depression (measure 5). Associations remained after adjustment for demographic and treatment-related factors (P = 0.006 to P = 0.050, measures 1-5), and were little attenuated after additional adjustment for subject-reported nonadherence (P = 0.011 to P = 0.072). There was a weaker, nonsignificant association with suicidal thoughts (measure 6). For risk of VL > 50 c/mL, all symptom measures were positively associated with rebound risk (P = 0.019 to P = 0.053, measures 1-6, adjusted for demographic and treatment-related factors; P = 0.022 to P = 0.084 after additional adjustment for nonadherence). CONCLUSIONS:Among patients on successful cART, physical and psychological symptoms were strongly predictive of viral rebound. Simple symptom inquiry may be valuable in the clinical setting to identify patients at risk of treatment failure, and provide opportunity for intervention.