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HIV/AIDS Research

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Targeting specific HIV-related symptoms that most diminish functioning would improve life for those with HIV disease

For people infected with the human immunodeficiency virus (HIV) that causes AIDS, some symptoms diminish their ability to function and overall quality of life more than others. Many of these symptoms can be successfully treated.

In order to provide optimal care and quality of life for patients with HIV, clinicians need to find ways to incorporate systematic symptom assessment more effectively into the time-constrained environment of routine clinical practice, conclude Martin F. Shapiro, M.D., Ph.D., of the University of California, Los Angeles, and Samuel A. Bozzette, M.D., Ph.D., of the University of California and the VA Healthcare System, San Diego. Drs. Shapiro and Bozzette are co-principal investigators of the HIV Cost and Services Utilization Study (HCSUS), which is supported in part by the Agency for Healthcare Research and Quality (HS08578 and HS10227).

The researchers, who were led by Karl A. Lorenz, M.D., of the VA Healthcare System, Los Angeles, interviewed a nationally representative sample of 2,267 adults with known HIV infection in 1996 and again between 1997 and 1998. They asked patients to rate their current health and quality of life from 0 (worst) to 10 (best) and number of disability days (days in which at least half of the time was spent in bed because of poor health) to elicit the association of 14 HIV-related symptoms with perceived health, quality of life, and disability days.

Oral symptoms, gastrointestinal symptoms, labored breathing, pain, and weight loss affected 24 to 51 percent of HIV-infected patients initially evaluated. Among symptomatic patients, white patches in the mouth were associated with 4 percent lower perceived health scores, 6 percent lower perceived quality-of-life scores, and 1 additional disability day. Nausea (often a side effect of HIV drug treatment) was associated with 5 percent lower perceived health scores, 8 percent lower perceived quality-of-life scores, and 1 additional disability day. Dyspnea (labored breathing) was associated with 7 percent lower perceived health scores and 8 percent lower perceived quality-of-life scores.

Weight loss (greater than 2.25 kg or about 5 pounds) was associated with 3 percent lower perceived health scores and 4 percent lower perceived quality-of-life scores. Both dyspnea and weight loss were associated with additional disability days. Eye symptoms, extremity pain, and diarrhea were associated with poorer perceived quality of life, and headache and fever were associated with increased disability days.

See "Associations of symptoms and health-related quality of life: Findings from a national study of persons with HIV infection," by Karl A. Lorenz, M.D., Dr. Shapiro, Steven M. Asch, M.D., M.P.H., and others, in the May 1, 2001 Annals of Internal Medicine 134(9), pp. 854-860.

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