Patterns of Change in Symptom Clusters with HIV Disease Progression

Abstract

Context With better antiretroviral treatments (ARTs), persons living with HIV (PLWH) are living longer, healthier lives. Therefore, they also experience more medical comorbidities that come with normal aging, as well as side effects of multiple treatments and long-term sequelae of HIV. It can be hard to know whether symptoms reported by PLWH are related to comorbidities or are signs of HIV disease progression and possible treatment failure. Objectives The current study was designed to disentangle these issues by examining within-person symptom changes in data collected from a cohort of PLWH before the advent of highly efficacious ART. Methods This study was a secondary analysis of symptom reports in longitudinal data collected from 246 PLWH in 1992–1994. Multilevel modeling was used to test for changes over time in HIV-related symptom clusters. Analyses also tested the effects of person-level demographic covariates and co-occurring mental health symptoms on HIV symptoms and examined the magnitude of within-person versus between-person variations in reported symptom severity. Results Two of six HIV-related symptom clusters, malaise/fatigue and nausea/vomiting, increased over time in the context of HIV disease progression, but the other four did not. Changes were independent of baseline disease severity or psychological covariates. There was substantial within-person variability in absolute symptom severity. Conclusion Relatively small but consistent changes in symptoms related to nausea or fatigue may suggest HIV disease progression, but changes in other HIV symptom clusters may instead be related to comorbidities or normal aging. Further research is recommended on symptom progression in PLWH.