Burden and risk factors for gastrointestinal symptom distress in HIV patients in the modern antiretroviral era

ABSTRACT

In the modern antiretroviral (ARV) era, there is limited knowledge about the prevalence and risk factors for HIV patient-reported gastrointestinal (GI) symptoms (diarrhoea/soft stool, nausea/vomiting, bloating/painful abdomen, loss of appetite, and weight loss/wasting) and distress. We prospectively analysed data (2007–2014) on distressing GI symptoms from the Ontario HIV Treatment Network Cohort Study, which follows people attending HIV clinics. Using generalized estimating equations with a logit link, we estimated the associations of psychosocial, demographic, behavioural, and clinical factors with each GI symptoms compared to asymptomatic and non-bothersome symptoms. Among 1532 included participants, 80.4% were male, mean age was 45 years, and 64.6% reported being men who have sex with men. Most were Caucasian (56.3%), a median time since HIV diagnosis of 9.8 years (interquartile range (IQR): 4.1–16.9), and 83.1% were on ARV. More than two-thirds (68.7% (95% confidence intervals (CI): 63.1% to 69.2%)) reported one or more symptoms with a median of 1.2 (IQR: 0–1.7). The proportion remained stable over time since HIV diagnosis and ARV initiation. Risk factors varied for multivariable models. A strong association with Centre for Epidemiologic Studies Depression scale scores of ≥23 was found for all symptoms. Adjusted odds ratios (95% CI) were 1.72 (1.39–2.12), 2.95 (2.33–3.72), 2.20 (1.81–2.68), 4.97 (3.99–6.19), and 2.98 (2.52–3.82) for diarrhoea, nausea/vomiting, bloating, loss of appetite, and weight loss, respectively. With the exception of bloating, odds were significantly lower for those on ARV containing integrase inhibitors and greater for patients reporting current cannabis use. GI symptoms in the modern ARV era are highly prevalent and may arise as a common pathway of distress in response to psychosocial vulnerabilities, regardless of the stage of diagnosis. These findings support the need for integrated approaches to address psychological and physical distress in HIV disease.

KEYWORDS:

• HIV
• gastrointestinal tract
• diarrhoea
• nausea
• bloating
• vomiting
• weight loss

Acknowledgements

We gratefully acknowledge all of the people living with HIV who volunteered to participate in the OCS and the work and support of the past and present members of the OCS Governance Committee: Adrian Betts, Anita C. Benoit, Breklyn Bertozzi, Les Bowman, Lisungu Chieza, Tracey Conway, Patrick Cupido (Chair), Tony Di Pede, Brian Finch, Michael J. Hamilton, Brian Huskins, Rick Kennedy, Ken King, Nathan Lachowsky, Joanne Lindsay, Shari Margolese, Mark McCallum, John McTavish, Colleen Price, Lori Stoltz, Darien Taylor, Rosie Thein, and Drs Ahmed Bayoumi, Evan Collins, Curtis Cooper, Clemon George, Troy Grennan, Claire Kendall, and Greg Robinson. The OCS Team consists of Dr Sean B. Rourke (Principal Investigator), University of Toronto and OHTN; Dr Sergio Rueda, CAMH; Dr Ann N. Burchell, Dr Ahmed Bayoumi, Dr Kevin Gough, and Dr Darrell Tan, St. Michael’s Hospital; Dr Jeffrey Cohen, Windsor Regional Hospital; Dr Curtis Cooper, Ottawa General Hospital; Dr Don Kilby, University of Ottawa Health Services; Dr Mona Loutfy and Dr Fred Crouzat, Maple Leaf Medical Clinic; Dr Anita Rachlis and Dr Nicole Mittmann, Sunnybrook Health Sciences Centre; Dr Janet Raboud and Dr Irving Salit, Toronto General Hospital; Dr Edward Ralph and Dr Michael Silverman, St. Joseph’s Health Care; Dr Roger Sandre, Sudbury Regional Hospital; and Dr Gerald Evans and Dr Wendy Wobeser, Hotel Dieu Hospital. We thank all the interviewers, data collectors, research associates and coordinators, nurses, and physicians who provided support for data collection and extraction. The authors wish to thank the OCS staff for data management, IT support, and study coordination: Madison Kopansky-Giles, Jason Globerman, Beth Rachlis, Robert Hudder, Gokul Kalaimani, Lucia Light, Veronika Moravan, and Nahid Qureshi. We also extend our thanks to Veronika Moravan and Lucia Light for their assistance with database management, along with members of our Community Advisory Committee: Adrian Betts, Stephen Tattle, Maggie Atkinson, and Sean Hosein. We also acknowledge the Public Health Laboratories, Public Health Ontario, for supporting record linkage with the HIV viral load database. T.J.O, J.R., J.T., S.B.R, S.G., C.C., S.R., T.A.H., A.R., and A.N.B. designed the study. T.J.O., J.R., and S.G. managed the data. T.J.O. and S.G. performed statistical analyses and created all tables. T.J.O. prepared the initial draft manuscript. All authors contributed to editing and approved the final versions of the manuscript. The opinions, results, and conclusions are those of the authors, and no endorsement by the Ontario HIV Treatment Network or Public Health Ontario is intended or should be inferred.

Disclosure statement

J.R. was a co-investigator in two other research studies unrelated to this work which were supported with in-kind contributions from Merck and Gilead Sciences, respectively. All other authors have no conflict of interest to declare related to this work. The funders had no role in the study design, data analysis, decision to publish, or preparation of the manuscript.