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People with HIV vary in their physical and role functioning

Even with recent improvements in antiretroviral therapy, people infected with the human immunodeficiency virus (HIV) that causes AIDS vary widely in their ability to function physically and socially. Those who suffer from intense symptoms, pain, or fatigue are most likely to be limited in their functioning. However, the wide range of functioning in HIV-infected people underscores the need for individualized care plans, according to a study by Stephen Crystal, Ph.D., of Rutgers University, John A. Fleishman, Ph.D., of the Agency for Healthcare Research and Quality, and their colleagues. The researchers assessed the physical and role limitations experienced by 2,836 HIV-infected people enrolled in the HIV Cost and Services Utilization Survey (HCSUS), a nationally representative survey of people receiving care for HIV in the United States.

A majority (51 percent) of people experienced difficulty at least some of the time in carrying out their roles, such as working at a job, doing household chores, or going to school. More people were limited in this type of role than for any specific physical tasks except for vigorous activities (64 percent). For physical tasks, individuals were most limited in their ability to perform energy-demanding activities such as climbing stairs (43 percent) or walking more than a block (26 percent) than in self-care tasks such as bathing and dressing (14 percent).

Individuals who were older, less educated, had more advanced disease, or had a higher symptom burden tended to be more limited. For example, men and women with asymptomatic disease reported few limitations involving mostly vigorous and energy-demanding activities. However, more than 80 percent of those with AIDS were limited in vigorous activities, and a majority were limited in climbing stairs and walking more than 1 mile; 21 percent had difficulty bathing or dressing themselves. Seventy-two percent of those with AIDS were limited at least some of the time in work, school, or housework. Symptoms most significantly associated with increased limitations included nausea, cough, and diarrhea. Treatment with protease inhibitors was associated with somewhat less physical limitation but no difference in role limitation.

See "Physical and role functioning among persons with HIV: Results from a nationally representative survey," by Drs. Crystal and Fleishman, Ron D. Hays, Ph.D., and others in the December 2000 Medical Care 38(12), pp. 1210-1223.

Reprints (AHRQ Publication No. 01-R018) are available from the AHRQ Publications Clearinghouse.

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