A symptom review: nausea and vomiting in HIV

Use of Dronabinol Improves Appetite and Reverses Weight Loss in HIV/AIDS-Infected Patients

Objective: To determine whether dronabinol affects appetite and weight status in patients living with HIV/AIDS. Methods: A retrospective chart review was conducted to analyze weight and appetite changes and nausea status in patients with HIV/AIDS who received dronabinol for 3 to 12 months from January 11, 1993, to March 17, 2003. Results: Of the 117 patients who lost weight before baseline, 63% maintained or gained weight. In patients receiving dronabinol for 1 year, the mean weight gain (± SD) was 3.7 ± 10.6 lb. The percentage of patients experiencing loss of appetite decreased significantly from 71% at baseline to 26% at 1 month (P < .001) and continued to decline throughout the trial. The percentage of patients experiencing nausea at baseline (38%) decreased consistently from week 2 on; this change from baseline was significant at month 6 (P = .031). Conclusion: When taken for 3 months to 1 year, dronabinol significantly improves appetite and reverses weight loss in patients living with HIV/AIDS.

Integration of palliative care throughout HIV disease

People with HIV have a high burden of pain and physical, psychological, and social difficulties that can be managed effectively with palliative care. However, most individuals do not have access to this type of care. Palliative care is holistic patient-centred management of life-limiting progressive disorders and is recognised by WHO as an essential element of HIV care, from diagnosis to end of life. Historically, palliative care and HIV care were linked closely, but misconceptions divide the two disciplines today. Palliative care can augment patients' outcomes and boost adherence to antiretroviral treatments and life expectancy. In much of the world, services providing palliative care are isolated, and most individuals in need have no access to this care. The commitment to provide palliative care for all people with HIV can be fulfilled if clinical workers are trained in this therapeutic approach and if care is delivered at community level, with support for family caregivers.

Nausea and vomiting in HIV/AIDS

HIV infection has become a chronic illness with the availability of potent antiretroviral agents. Many of the agents used to manage HIV, however, have been associated with distressing symptoms such as nausea and vomiting posing challenges to maintain adherence to therapy and quality of life. This article highlights the mechanism, evaluation, and management of HIV-associated nausea and vomiting. Supportive symptom management information is also presented.

Symptom management for HIV-positive persons in Norway

PURPOSE

To record symptoms experienced by people with HIV/AIDS, and describe useful self-care strategies and how symptoms impact on daily life.

METHOD

A questionnaire was used with self-reported answers and descriptions of how symptoms impact on daily activities and suggestions for useful self-care strategies. Four hundred and twenty-two (n = 422) HIV-positive persons from seven sites in the USA and one site in Norway (n = 20) answered the questionnaire.

RESULTS

In this article subjective symptom descriptions from the Norwegian sample are presented along with self-care strategies and their effectiveness. Findings revealed the Norwegian sample to be a little older, maybe less anxious and depressed, than participants in the larger study. This difference might be explained by the structure of the national social and health care system in Norway, where treatments, medications and social services are available to all citizens without cost. Respondents described a number of related symptoms as well as their subjective explanations of what triggered the symptoms. Most of the self-care strategies were learnt by trial and error.

RECOMMENDATIONS

Community health providers, nurses and physicians should become more knowledgeable about the symptoms that infected persons struggle with, as well as the impact these symptoms have on routine daily self-care activities and a person's quality of life. There is need for more research about helpful self-care strategies to assist HIV-positive persons to manage their symptoms and to disseminate these to community health providers and support groups for HIV infected persons.

Characteristics of nausea reported by HIV-infected patients initiating combination antiretroviral regimens

Reliable data on the incidence and severity of nausea accompanying combination antiretroviral therapies is lacking. A prospective time series design was used to assess the rate, severity, and distress of nausea in a cohort of 75 HIV-positive patients who were beginning or changing a combination of two or more antiretroviral medications. Data were collected via telephone at weekly intervals for 12 weeks. The rate of nausea across regimens was greatest at Week 1 (39%) and declined progressively over time. By Week 12, the rate of nausea was only 5%. Severity of nausea was ranked as moderate or severe by a substantial proportion of patients through Week 10; however, nausea severity and distress were also found to diminish over time. The nausea associated with combination antiretroviral therapy is quite common and may adversely affect medication adherence. Findings indicate that clinicians should consider initiating interventions for management of antiretroviral-related nausea at baseline.