Symptom prevalence, characteristics, and distress in AIDS outpatients

Symptom distress is an important but poorly characterized aspect of quality of life in AIDS patients. To assess and characterize the symptoms and symp tom distress associated with AIDS 504 ambulatory patients with AIDS were ev aluated between December, 1992 and December, 1995. The assessment included measures of symptom distress, physical and psychosocial functioning; and de mographic and disease-related factors. Patients described symptoms during t he previous week using the Memorial Symptom Assessment Scale Short Form (MS AS-SF), a validated measure of physical and psychological symptom distress. The mean age was 38.6 years (range 18-69); 56 % were male. African-America ns comprised 40 % of the sample, Caucasians 35 %, and Hispanics 23 %. Ninet y-three percent had CD4+ T-cell counts below 500 and 66 % had counts below 200; 69 % were classified in CDC category C (history of AIDS-defining condi tions). Fifty-two percent reported intravenous drug use. Karnofsky performa nce status was greater than or equal to 70 in 80 % of the patients. No pati ents were taking protease inhibitors. The mean (+/- SD) number of symptoms was 16.7 +/- 7.3. The most prevalent symptoms were worrying (86 %), fatigue (85 %), sadness (82 %), and pain (76 %). Patients with Karnofsky performan ce scores < 70 had more symptoms and higher symptom distress scores than pa tients with scores greater than or equal to 70 (21.2 +/- 6.5 vs. 15.6 +/- 7 .1 symptoms/patient; 2.3 +/- 0.8 vs. 1.6 +/- 0.8 on the Global Distress Ind ex [GDI] of the MSAS-SF; P < 0.0001 for both). Patients who reported intrav enous drug use as an HIV transmission factor reported more symptoms and hig her overall and physical symptom distress than those who reported homosexua l or heterosexual contact as their transmission factor (17.8 +/- 7.5 vs. 15 .4 +/- 6.9 symptoms/patient, P = 0.0002; 1.9 +/- 0.9 vs. 1.6 +/- 0.8 on the MSAS-GDI, P = 0.002). Both the number of symptoms and symptom distress wer e highly associated with psychological distress and poorer quality of life; for example, r = -0.69 (P < 0.0001) between GDI scores and scores on a vali dated measure of quality of life. Neither gender nor CD4+ T-cell count was associated with symptom number or distress. Responses from this self-referr ed sample of AIDS outpatients indicate that AIDS patients experience many d istressing physical and psychological symptoms and a high level of distress . Both the number of symptoms and the distress associated with them are ass ociated with a variety of disease-related factors and disturbances in other aspects of quality of life. Symptom assessment provides information that m ay be valuable in evaluating AIDS treatment regimens and defining strategie s to improve quality of life. J Pain Symptom Manage 1999;18:253-262. (C) U. S. Cancer Pain Relief Committee, 1999.