Is antiretroviral therapy associated with symptom prevalence and burden?

Although distressing pain and other symptoms have been reported at all stages of HIV disease, studies have not taken account of the relative contribution of treatment side-effects and underlying disease. This study aimed to assess the prevalence of symptoms, their burden and the association with use of highly active antiretroviral therapy (HAART). Three hundred and forty-seven gay men with HIV disease completed an online survey, reporting data on age, CD4, viral load, year of diagnosis, HAART use, and the Memorial Symptom Assessment Scale Short Form (MSAS-SF).Those men currently receiving HAART (n=210, 56.6%) reported a higher number of symptoms than those without (14 versus 10.3, P=0.001). Fourteen physical symptoms were significantly more frequent among HAART users. Symptoms of psychological distress were the most common in both groups, ranging from 69.2% to 79.5%. Mean distress indices were higher for those on treatment with respect to both global (P=0.011) and physical (P=0.001) distress. In multivariate analysis, use of HAART was independently associated with number of physical symptoms (b=2.81, P=0.006), and physical distress score (b=2.45, P=0.017); both increasing with HAART use when controlling for age, year of diagnosis, CD4 and viral load. The high symptom prevalence, particularly psychological symptoms, is comparable with end-stage malignant and non-malignant diseases. Greater attention needs to be paid to the assessment and management of burdensome symptoms.

The outbreak and control of Ebola viral haemorrhagic fever in a Ugandan medical school.

Uganda has just experienced the largest outbreak of Ebola haemorrhagic fever (EHF) ever recorded. Mbarara University Teaching Hospital (MUTH) is responsible for training approximately one-third of Uganda's doctors. Mbarara is located in SouthWest Uganda, 614 km from Gulu, the main epicentre of the outbreak. On 23 October a patient was admitted to the medical ward of MUTH with an acute fever. He soon exhibited haemorrhagic symptoms and died. He was later confirmed to have suffered Ebola. Three more patients subsequently contracted the disease. All died. There were no further cases in Mbarara. No members of staff or medical student was infected. We give details of the clinical features of those patients who contracted the disease, the setting up of an Ebola isolation unit, the case surveillance and the search for the source of the outbreak. The implications for similar institutions in East Africa are discussed.