Symptom Burden of Fatigue in Men and Women Living With HIV/AIDS in Southern Africa

Abstract

HIV-related fatigue is a debilitating and disabling symptom that persists for months and years. In 743 HIV/AIDS patients from Southern Africa, the authors found ratings of HIV-related fatigue to be highly prevalent. The authors conducted a secondary data analysis within the theoretical context of the University of California, San Francisco Symptom Management Model. The analysis focused on 538 patients who reported fatigue to investigate correlates and predictors of fatigue severity in relationship to demographic and HIV/AIDS illness indicators, as well as HIV-specific physical and psychological symptoms. A hierarchical regression model explored the contributions of those five blocks on fatigue severity. Of the 47% of the total variance in fatigue severity, a combination of variables within the health and illness block (6%), the physical symptoms block (7%) and the psychological symptom block (2%) contributed significantly to the increase in fatigue severity scores. Fatigue severity in Southern Africa was moderate, and the factors contributing to the perceived fatigue were most likely related to symptoms of acute HIV disease (such as fever and gastrointestinal problems). In conclusion, fatigue severity is less impacted by demographic or environmental variables but much more by co-occurring symptoms and HIV disease severity. The results of this study imply the need for more research to understand if improvements in water quality and access to food would prevent infection and diarrhea and whether sufficient access to antiretroviral treatments to manage the HIV infection would improve fatigue and co-occurring symptom profiles.

Pain in ambulatory HIV‐positive South Africans

“…The prevalence of pain in our study participants (rural 72%, metropolitan 56%) was within the range reported for HIV‐positive outpatients from the same hospital from which we recruited our metropolitan cohort (Rosen et al., ) and for other HIV‐positive outpatients in sub‐Saharan Africa (Hughes et al., ; Shawn et al., ; Uwimana and Struthers, ; Voss et al., ; Hitchcock et al., ; Peltzer and Phaswana‐Mafuya, ). With the exception of the study of Hitchcock et al.…”

“…The prevalence of pain in our study participants (rural 72%, metropolitan 56%) was within the range reported for HIV-positive outpatients from the same hospital from which we recruited our metropolitan cohort (Rosen et al, 2008) and for other HIV-positive outpatients in sub-Saharan Africa (Hughes et al, 2004;Shawn et al, 2005;Uwimana and Struthers, 2007;Voss et al, 2007;Hitchcock et al, 2008;Peltzer and Phaswana-Mafuya, 2008). With the exception of the study of Hitchcock et al (2008), which was concerned specifically with neuropathic pain, none of other studies reporting pain prevalence pursued the characteristics of the pain; they mainly were qualityof-life studies, in which pain was reported as one of many symptoms accompanying HIV infection.…”

“…). Ambulatory HIV‐positive patients in sub‐Saharan Africa are very unlikely to confine themselves to bed (Voss et al., ). Some (Mathews et al., ; Dobalian et al., ; Gray and Berger, ), but not all (Breitbart et al., ), previous studies have reported that HIV‐positive patients of African ancestry are less compromised by their pain than are patients of Caucasian ancestry.…”

“…Therefore, a significant portion of the world's population of people infected with HIV potentially have increased risk of experiencing moderate-to-severe pain, and for this pain to be undertreated. Indeed, studies on quality of life in African HIV-positive populations have shown that pain is a frequent complaint of infected individuals (Hughes et al, 2004;Shawn et al, 2005;Uwimana and Struthers, 2007;Voss et al, 2007;Peltzer and Phaswana-Mafuya, 2008;Rosen et al, 2008), with pain prevalence being over 90% in patients with advanced disease (Norval, 2004;Narasimooloo et al, 2011). Management of pain also was poor in hospitalized patients and those with chronic pain (Maree et al, 2011;Narasimooloo et al, 2011).…”

Pain Among Ambulatory HIV/AIDS Patients: Multicenter Study of Prevalence, Intensity, Associated Factors, and Effect

“…51 This sample frequently experienced pain in the head, chest and abdomen, sites which have been consistently documented in HIV-infected patients. 2,25,43,65 The study findings also indicate a low level of prescription of opioids. Of the 39 patients who reported severe pain on the day of the survey, only 13 (33%) were prescribed a strong opioid analgesic in line with the WHO pain ladder.…”