Maintaining wellbeing for South Africans receiving ART: the burden of pain and symptoms is greater with longer ART exposure

Physical and psychological symptom burden among people with HIV infection is associated with poor quality of life, poorer treatment adherence, viral rebound and risk behaviour. Symptomatology has not been investigated among outpatients in sub-Saharan Africa. To measure the seven-day period prevalence, burden and correlates of pain and other physical and psychological symptoms among HIV patients receiving antiretroviral therapy (ART). This was a cross-sectional self-report study. A total of 378 patients were interviewed using validated tools in three South African public sector clinics. The most prevalent symptoms were feeling sad (64%), feeling irritable (61.6%), worry (60.8%), numbness and tingling in hands/ feet (59.8%), and sexual problems (51%). In multivariate analysis, later disease stage was associated with worse psychological symptom burden (beta = 0.359; 95% confidence interval (CI) 0.202 - 0.516; p < or = 0.001), global symptom burden (beta = 0.365; 95% CI 0.204 - 0.526; p < 0.001) and number of symptoms (beta = 0.308; 95% CI 0.150 - 0.465; p < 0.001). Those receiving treatment for a greater number of years also reported higher burden for physical (beta = 0.083; 95% CI 0.037 - 0.129; p < or = 0.001), psychological (beta = 0.068; 95% CI 0.019 - 0.117; p = 0.007) and global symptoms (beta = 0.065; 95% CI 0.016 - 0.115; p = 0.010), and a greater number of symptoms (beta = 0.081; 95% CI 0.032 - 0.130; p = 0.001). The data reveal a high symptom burden despite treatment. Detailed symptom assessment and control continues to be required in the era of treatment.