HIV-related symptoms and management in HIV and antiretroviral therapy patients in KwaZulu-Natal, South Africa: A longitudinal study

Figures & data

Table 1. Sample characteristics and study attrition analysis.

	Baseline (Time 1)		Stayed in the study (Time 4)
Variable	N = 735 or M	% or SD	N = 499	% or SD	χ^2 or t-test	p
Sex
Male	217	29.5	137	63.1	3.2	0.07
Female	518	70.5	362	69.9
Age, range 18–67	35.9	9.7	36.1	9.5	–0.82	0.42
Education
Grade 7 or less	279	38.1	199	71.3	4.39	0.04
Grade 8–11	314	42.9	214	68.2	0.02	0.9
Grade 12 or more	139	19	84	60.4	4.39	0.04
Religion
African or none	187	25.4	121	64.7	1.17	0.28
Mainstream Christian	154	21	99	64.3	1.16	0.28
Charismatic	271	36.9	194	71.6	2.69	0.1
Residence
Rural (village)	338	46.2	215	63.6	5.19	0.02
Rural (farm)	125	17.1	95	76	4.59	0.03
Urban (informal settlements)	41	5.6	32	78	2.07	0.15
Urban (formal settlements)	227	31.1	154	67.8	0	1
Employment status
Housewife/houseman	99	13.5	74	74.7	2.37	0.12
Unemployed	448	61.2	290	64.7	5.78	0.02
Employed	148	20.2	110	74.3	3.38	0.07
Pensioner/disabled/student	24	3.4	14	56	1.72	0.19
Income
Formal salary	215	29.9	157	73	2.94	0.09
Family member contributions	133	18.5	89	66.9	0.18	0.67
Social grants	264	36.7	182	68.9	0.04	0.84
Disability grant (for chronic illness)	129	23.8	89	69	0.27	0.61
Child care support grant	383	52.3	262	68.4	0.13	0.71
No income	57	7.9	38	63.2	0.81	0.37
Time since HIV diagnosis
≤1 year (2007/8)	540	73.5	367	68	0.01	0.95
1–2 years (2006)	73	9.9	55	75.3	2.06	0.15
>2 years (2005–1995)	122	16.6	77	63.1	1.53	0.22
CD4 count (cells/µL)
1–99	106	19.7	91	85.8	0.2	0.66
100–349	345	64.2	300	87	0.03	0.86
≥350	86	16	77	89.5	0.52	0.47
The number of HIV symptoms (range: 0–64)	7.2	9.5	6.8	9.3	2.64	0.008
Internalised stigma (range: 0–6)	3.8	2.4	4.2	2.7	–0.99	0.32
Discrimination experiences (range: 0–7)	0.3	1	0.3	0.6	0.5	6.7
AUDIT scores (range: 0–12)	0.4	1.4	0.6	1.3	–0.78	0.43

Table 2. Symptom frequency (mild, moderate, or severe) in percentage over time.

Problem	Time 1	Rank	Time 2	Rank	Time 3	Rank	Time 4	Rank
1. Concern over weight loss	35.7	1	1.5	29	0.4	22	0
2. Headaches	32.1	2	6.3	2	2.5	1	1.2	5
3. Dry mouth	31.7	3	4.0	5	0.5	12	0
4. Memory loss	27.0	4	3.8	6	0.4	23	0
5. Weakness	24.8	5	3.4	8	0.5	13	0
6. Thirsty	24.2	6	2.9	14	0		0
7. Painful joints	23.6	7	3.8	7	1.3	5	1.8	1
8. Chills (feeling very cold)	23.1	8	9.9	1	0.9	8	0.2	15
9. Chest pain	22.9	9	3.1	11	1.3	6	0.2	16
10. Numbness/tingling of legs	21.3	10	3.1	12	1.4	3	0
11. Lack of appetite	20.9	11	2.7	`6	1.4	4	1.4	3
12. Diarrhoea	20.3	12	5.4	3	2.0	2	1.6	2
13. Numbness/tingling of feet/toes	20.3	13	2.3	21	0.4	24	0
14. Heart racing	17.5	14	1.1	35	0.2	41	0
15. Fatigue	17.4	15	1.9	24	0.2	42	0
16. White spots in mouth/thrush	17.3	16	1.3	30	0.5	14	0.4	11
17. Numbness/tingling of hands/fingers	17.1	17	2.9	15	0.4	25	0
18. Night sweats	16.3	18	2.3	22	0		0.2	17
19. Dizziness	15.6	19	3.4	9	0.4	26	1.2	6
20. Muscle aches	15.0	20	1.3	31	0.4	27	0.2	18
21. Depression (sadness)	14.8	21	2.5	19	0.5	15	0
22. Fear/worry	14.2	22	2.5	20	0.4	28	0
23. Nausea	14.1	23	2.7	17	0.4	29	0
24. Rash	13.8	24	2.7	18	0.5	16	0.4	12
25. Numbness/tingling of arms	13.1	25	1.7	27	0		0
26. Day sweats	12.8	26	2.1	23	0.2	43	0
27. Difficulty concentrating	12.0	27	1.1	36	0.4	30	0
28. Abdominal pain	11.9	28	1.3	32	0.5	17	0.8	9
29. Insomnia/cannot sleep	11.6	29	0.6	49	0		0
30. Hump on back of neck/shoulders	11.6	30	1.1	37	0.4	31	0
31. Vomiting	11.5	31	1.0	41	0.7	11	0
32. Loose stools	10.9	32	1.9	25	0.4	32	0.2	19
33. Coughing/problems catching breath	10.5	33	0.8	43	0.9	9	1.2	7
34. Fever	10.0	34	3.4	10	1.1	7	1.4	4
35. Easy bruising	9.4	35	0.4	54	0		0.2	20
36. Itchy skin	9.3	36	1.3	33	0.9	10	0.6	10
37. Concern over weight gain	8.6	37	4.6	4	0.5	18	0
38. Anxious	8.5	38	0.4	55	0.2	44	0
39. Burning with urination	8.3	39	0.8	44	0.4	33	0.2	21
40. Shortness of breath at rest	7.9	40	0.4	56	0	55	0
41. Shortness of breath with activity	7.4	41	0.6	50	0.2	45	0
42. Weight gain in stomach area	7.4	42	1.7	28	0.5	19	0.2	22
43. Swollen feet	7.0	43	1.1	38	0.4	34	0.4	13
44. Skinny arms and legs	6.7	44	0.8	45	0.2	46	0
45. Rectal discharge	6.7	45	1.1	39	0.4	35	0
46. Mouth ulcers	6.6	46	0.2	61	0.2	47	0
47. Wheezing	6.0	47	0.6	51	0.2	48	0
48. Seizures/tremors	6.0	48	1.1	40	0		0
49. Constipation	5.8	49	0.2	62	0.4	36	0.2	23
50. Blurred vision	5.7	50	2.1	24	0.4	37	0
51. Sore throat	5.6	51	0.2	63	0.5	20	0.2	24
52. Rectal itching	5.5	52	0.8	46	0		0
53. Gas/bloating	5.2	53	3.1	13	0.5	21	0
54. Painful swallowing	5.2	54	0	64	0.4	38	0
55. Nipple discharge	5.2	55	0.8	47	0		0.2	25
56. Rectal bleeding	4.9	56	1.3	35	0		0
57. Swollen glands	4.8	57	0.4	57	0		1.2	8
58. Prominent leg veins	4.4	58	1.0	42	0.4	39	0
59. Flushing	4.2	59	0.4	58	0		0.4	14
60. Sore/bleeding gums	3.8	60	0.8	48	0		0
61. Breast pain/changes	3.7	61	0.4	59	0.4	40	0.2	26
62. Sores or lumps on genitals	3.7	62	0.6	52	0		0.2	27
63. Blood in spit/sputum	3.4	63	0.4	60	0.2	49	0.2	28
64. Nose bleeds	2.6	64	0.6	53	0		0.2	29
Total mean (SD)	7.5 (9.6)		1.2 (2.6)		0.3 (2.1)		0.2 (0.9)

Table 3. Predictors of the HIV-related symptom burden.

Variables	β coefficient (95% CI)	p	Adjusted β coefficient(95% CI)^a	p
Sociodemographic variables
Age	0.01 (–0.004, 0.014)	0.307	–
Male vs. female	0.05 (–0.14, 0.25)	0.589	–
Educational level	0.05 (0.01, 0.09)	0.014	0.12 (–0.01,0.24)	0.05
Never married/widowed/separated/divorced vs. married or cohabiting
	0.05 (–0.14, –0.25)	0.602	–
Urban vs. rural residence	–0.77 (–0.95, –0.59)	<0.001	0.24 (–0.33, 0.81)	0.406
Formal/informal employment vs. not	–1.03 (–1.23, –0.84)	<0.001	–2.36 (–3.00, –1.72)	<0.001
Clinical variables
Time since HIV diagnosis	–0.09 (–0.21, 0.03)	0.147	–
CD4 count (cells/µL)	–3.41 (–5.44, –1.39)	0.001	–0.01 (–0.011, –0.017)	<0.001
Social variables
Internalised stigma scores	0.54 (0.49, 0.59)	<0.001	0.66 (0.57, 0.76)	<0.001
Discrimination experiences score	–0.31 (–0.44, –0.17)	<0.001	0.25 (–0.14, 0.64)	0.204
Alcohol use score	0.24 (0.07, 0.42)	0.007	0.33 (0.14,0.51)	<0.001

Note: All variables with p < .05 in the baseline HIV-related symptom burden adjusted model were eligible for the multivariate model.

^aGoodness of fit quasi-likelihood under independence model criterion value = 44,318.46.

Table 4. HIV- or ARV-related self-reported symptoms.

	Time 1		Time 2		Time 3		Time 4
	N	Rank order	N	Rank order	N	Rank order	N	Rank order
Headaches	56	2	83	1	38	1	8	3
Diarrhoea	48	3	51	2	17	3	97	1
Rash	25	8	45	3	15	4	10	2
Nausea and vomiting	25	8	41	4	11	6	1	9
Numbness/tingling of legs/arms/hands/feet (neuropathy)	17	13	21	5	23	2	1	9
Pain (chest, leg, body)	24	9	20	6	17	3	5	5
Lack of appetite	26	7	11	7	13	5	4	6
Fatigue	22	11	6	9	2	10	1	9
Tuberculosis	175	1			1	11	2	8
Herpes	26	38	2
Stomach problem	19	12	5	10	7	7	3	7
Thrush	17	13	5	10
Chills (feeling very cold)					5	8	6	4
Weight loss	39	4
Cough	33	5	9	8
Discharge disorder; STI	28	6	2	12	3	9
Memory loss			9	8	7	7
Night sweats	5	16	5	10
Itchy skin	7	14	2	12
Swollen glands	6	15
Dry mouth			3	11	1	11
Fever	4	17
Sexual problem	1	19			1	11
Weight gain					1	11

Table 5. Type of symptom management strategy and perceived effectiveness.

	Time 1 (n = 735)		Time 2 (n = 519)		Time 3 (n = 557)		Time 4 (n = 499)
	N (%)	M effect	N (%)	M effect	N (%)	M effect	N (%)	M effect
Medication	403 (65.7)	1.9 (0.9)	177 (85.9)	2.4 (0.6)	100 (22.5)	2.2 (0.6)	39 (28.9)	2.8 (0.4)
Complementary/traditional treatments	230 (37.0)	1.5 (0.6)	25 (30.9)	2.4 (0.6)	13 (2.9)	2.8 (0.5)	0	0
Self-comforting	250 (39.9)	1.5 (0.7)	23 (28.4)	1.5 (0.6)	13 (2.9)	2.2 (0.7)	4 (3.0)	2.3 (0.5)
Change in diet	377 (39.7)	1.5 (0.7)	17 (21.8)	1.8 (0.4)	4 (0.9)	2.0 (0.8)	1 (0.7)	3
Seeking help	241 (38.5)	1.5 (0.7)	17 (22.7)	1.4 (0.5)	8 (1.8)	1.8 (0.7)	2 (1.5)	2.5 (0.7)
Exercise	37 (5.9)	1.9 (0.9)	5 (7.4)	1.7 (0.8)	4 (0.9)	2.8 (0.5)	0	0
Spiritual care	208 (33.3)	1.6 (0.7)	45 (46.4)	2.2 (0.7)	20 (4.5)	2.6 (0.6)	2 (1.5)	2.0 (0.0)
Daily thoughts/activities	233 (37.3)	1.4 (0.6)	21 (26.6)	1.3 (0.5)	5 (1.1)	2.0 (1.0)	0	0