Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as “asymptomatic” by definition and treatment guidelines. This ...
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Abstract
Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as “asymptomatic” by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003–2005 and 2005–2007. Results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.
Keywords: HIV infection, symptoms, asymptomatic
BACKGROUND
In untreated HIV disease, more than ten years can elapse from initial infection to the first occurrence of an opportunistic infection (OI), an indicator that the disease has progressed to AIDS (
Panel on Antiretroviral Guidelines for Adult and Adolescents, 2006). This period of time does not mean, however, that people infected with HIV who have not yet progressed to AIDS are symptom free. Existing definitions and care guidelines that categorize patients as “asymptomatic” may lead clinicians to ignore symptoms that are not directly related to opportunistic infections, but that do require attention.
In 1986, the Centers for Disease Control (CDC) (
“Classification system for human T-lymphotropic virus type III/lymphadenopathy-associated virus infections,” 1986) provided an early description of HIV disease, which included two main categories: symptomatic and asymptomatic. For two decades, these definitions have been incorporated into treatment guidelines that have informed clinicians in the United States and other countries in their care for patients.
In the mid-1990s, with the ability to treat HIV itself, many clinicians began focusing solely on CD4 counts and symptoms directly related to OI (e.g. diarrhea, night sweats, fever). There has been growing evidence, however, that HIV-positive people experience many symptoms that are not directly related to OI or CD4 counts, particularly fatigue, depression, muscle aches, and fear/worries (
Corless, Nicholas, Davis, Dolan, & McGibbon, 2002;
Corless et al., In Press;
Eller et al., 2005;
Kemppainen et al., 2006;
J. Voss, Portillo, Holzemer, & Dodd, 2007;
J. G. Voss, 2005). These symptoms often go unrecognized and untreated by health care providers (
Hughes, 2004), either because care providers do not ask patients about their symptoms or because they consider the symptoms to be “sub-clinical”.
Siegel and colleagues (1999) reported that having symptoms, as well as their intensity, influenced decisions to seek care and have contributed to reduced adherence to medications, thereby increasing the likelihood of resistance to medication regimens and exacerbating symptoms. These factors may also reduce the physical and mental aspects of a person’s quality of life (
Abel & Painter, 2003;
Ammassari et al., 2001;
Corless et al., 2002;
Hudson, Kirksey, & Holzemer, 2004;
Lorenz, Cunningham, Spritzer, & Hays, 2006).
The aim of this study is to determine whether there are differences in the frequency and intensity of self-reported HIV symptoms among three levels of CD4 count (<200 cells/mm3, 200–350 cells/mm3, >350 cells/mm3), regardless of use of ARVs.
That took me 5 minutes.