Improvements in physical wellbeing over the first two years on antiretroviral therapy in western Kenya

Abstract

Improvements in physical wellbeing during the first six months on antiretroviral therapy (ART) are well known, but little is known regarding long-term follow-up. We conducted a prospective cohort study among 222 HIV-positive adult tea plantation workers in western Kenya to assess wellbeing over their first two years on ART. Study subjects completed a standardized questionnaire during repeat ART clinic visits. A 30-day recall period was used to elicit the number of days when subjects experienced poor health and the number of days that pain made it difficult to complete usual activities at home and work. A seven-day recall period was used to assess the severity of bodily pain, nausea, fatigue, and rash. Prevalence of most symptoms declined over time. A median of seven days poor health during the first month on ART declined to three days in the 24th month (p=0.043). For pain making usual activities difficult, a median of seven days during the first month on ART fell to zero by 12 months (p≤0.0001) but increased to three days by two years. Any bodily pain (range 59–83%) and fatigue (range 51–84%) over the past seven days were common through two years. However, pain and fatigue often over the past seven days declined over two years (from 24–10% (p=0.067) and 41–15% (p=0.002)). Skin rash was rare at all times, though higher at two years (8.6%) than any other time. Initial improvements in physical wellbeing were sustained over two years, however, increased pain and skin rash at year two may indicate problems as treatment programs mature. These improvements in physical wellbeing will be important in sustaining the long-term success of HIV treatment programs.

Keywords:

• HIV
• antiretroviral therapy
• wellbeing
• Africa

Acknowledgements

Funding for the research presented in this paper was provided by the Fogarty International Center of the National Institutes of Health through the International Studies in Health and Economic Development (ISHED) Program (Grant Number 5R01TW7181). We are deeply grateful to the workers who consented to be part of this study. We also extend our sincerest appreciation to the staff and management of the company, and especially the staff at the hospital, included in this study for their support and generous assistance. This paper is published with permission from the Director of the Kenya Medical Research Institute.

The Views expressed here are the opinions of the authors and are not to be considered as official or reflecting the views of the Walter Reed Army Institute of Research, the U.S. Army, the U.S. Department of Defense, and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.