2.50
Hdl Handle:
http://hdl.handle.net/10755/157702
Type:
Presentation
Title:
Getting to the Truth About Symptom Changes and HIV Disease Progression
Abstract:
Getting to the Truth About Symptom Changes and HIV Disease Progression
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Cook, Paul F., PhD
P.I. Institution Name:University of Colorado Denver, College of Nursing
Title:Assistant Professor
Contact Address:13120 E. 19th Ave., Campus Box C288-04, Aurora, CO, 80045, USA
Contact Telephone:303-724-8537
Co-Authors:Karen Sousa, Professor
Purpose/Aims: The purpose of this secondary data analysis was to examine symptom change in the context of HIV disease progression, illustrating the utility of hierarchical linear modeling to describe within-person symptom changes over time. Background: With more effective antiretroviral treatment (ART) and ongoing development of new drugs, HIV care is shifting from an acute to a chronic disease model. In this context, it becomes increasingly difficult to differentiate changes in patients' HIV -related symptoms from those due to normal aging processes and comorbidities. Hierarchical linear modeling is a novel analytic approach that can answer questions about changes in patients' symptom reports over time. As a first step in answering these complex questions, this secondary analysis examined changes in symptoms over the course of HIV disease progression, using data collected from a cohort of persons living with HIV (PLWH) at a time before effective ART was available. Participants: PLWH (N = 917) were participants in a longitudinal cohort study of HIV symptoms; all had progressed to AIDS based on a lab CD4 value < 500. From the total cohort, 246 participants had at least five data points after the time their CD4 dropped below 500, and these participants constituted the analysis sample. Methods: Participants completed the Sign and Symptom Check-List for Persons with HIV Disease (SSC-HIV) and items from the SF-36 health questionnaire at regularly scheduled clinic visits. Within-person changes on each of the SSCHIV's six subscales "malaise/fatigue, confusion/distress, fever/chills, gastrointestinal discomfort, shortness of breath, and nausea/vomiting" were modeled as a function of time since the AIDS-defining event of a first CD4 count < 500. Our hypothesis was that participants would have higher scores in each symptom category over time, based on HIV disease progression. A secondary question was whether psychological distress could account for the relationship between HIV disease progression and reported symptoms. Results: Participants had increasing symptoms over time on only two of the SSC-HIV subscales, malaise/fatigue (p=.001) and nausea/vomiting (p=.02). For the other four subscales, change over time was insignificant. All SSC-HIV subscales were affected by initial disease severity, but not by age. There were significant independent effects of the SF-36 "worry" item and the SSC-HIV distress subscale on all other symptom reports, which were additive to the effect of disease progression. As shown in Figure 1, PLWH differed substantially in their baseline symptom levels, and PLWH starting at different symptom severity levels showed similar changes in symptoms over time. Implications: HIV disease progression predicted increased symptom reports for some but not all symptom types. Changes in other symptoms therefore may be due to normal aging or other processes. Psychological distress contributed independently to reported symptom severity, and PLWH differed substantially in their symptom perceptions.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleGetting to the Truth About Symptom Changes and HIV Disease Progressionen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157702-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Getting to the Truth About Symptom Changes and HIV Disease Progression</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Cook, Paul F., PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Colorado Denver, College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">13120 E. 19th Ave., Campus Box C288-04, Aurora, CO, 80045, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">303-724-8537</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">paul.cook@ucdenver.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Karen Sousa, Professor</td></tr><tr><td colspan="2" class="item-abstract">Purpose/Aims: The purpose of this secondary data analysis was to examine symptom change in the context of HIV disease progression, illustrating the utility of hierarchical linear modeling to describe within-person symptom changes over time. Background: With more effective antiretroviral treatment (ART) and ongoing development of new drugs, HIV care is shifting from an acute to a chronic disease model. In this context, it becomes increasingly difficult to differentiate changes in patients' HIV -related symptoms from those due to normal aging processes and comorbidities. Hierarchical linear modeling is a novel analytic approach that can answer questions about changes in patients' symptom reports over time. As a first step in answering these complex questions, this secondary analysis examined changes in symptoms over the course of HIV disease progression, using data collected from a cohort of persons living with HIV (PLWH) at a time before effective ART was available. Participants: PLWH (N = 917) were participants in a longitudinal cohort study of HIV symptoms; all had progressed to AIDS based on a lab CD4 value &lt; 500. From the total cohort, 246 participants had at least five data points after the time their CD4 dropped below 500, and these participants constituted the analysis sample. Methods: Participants completed the Sign and Symptom Check-List for Persons with HIV Disease (SSC-HIV) and items from the SF-36 health questionnaire at regularly scheduled clinic visits. Within-person changes on each of the SSCHIV's six subscales &quot;malaise/fatigue, confusion/distress, fever/chills, gastrointestinal discomfort, shortness of breath, and nausea/vomiting&quot; were modeled as a function of time since the AIDS-defining event of a first CD4 count &lt; 500. Our hypothesis was that participants would have higher scores in each symptom category over time, based on HIV disease progression. A secondary question was whether psychological distress could account for the relationship between HIV disease progression and reported symptoms. Results: Participants had increasing symptoms over time on only two of the SSC-HIV subscales, malaise/fatigue (p=.001) and nausea/vomiting (p=.02). For the other four subscales, change over time was insignificant. All SSC-HIV subscales were affected by initial disease severity, but not by age. There were significant independent effects of the SF-36 &quot;worry&quot; item and the SSC-HIV distress subscale on all other symptom reports, which were additive to the effect of disease progression. As shown in Figure 1, PLWH differed substantially in their baseline symptom levels, and PLWH starting at different symptom severity levels showed similar changes in symptoms over time. Implications: HIV disease progression predicted increased symptom reports for some but not all symptom types. Changes in other symptoms therefore may be due to normal aging or other processes. Psychological distress contributed independently to reported symptom severity, and PLWH differed substantially in their symptom perceptions.</td></tr></table>en_GB
dc.date.available2011-10-26T20:07:23Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:07:23Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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