title: Differences in symptom expression in older HIV-positive patients: The Veterans Aging Cohort 3 Site Study and HIV Cost and Service Utilization Study experience.
abstract: Symptom recognition is critical for patient care but has been little studied in older HIV-infected individuals. The authors examined differences in symptom expression between younger (younger than age 50 years) and older (older than age 50 years) HIV-infected individuals. The authors analyzed data from two cross-sectional studies of HIV-infected individuals: 2864 individuals from the HIV Cost and Service Utilization Study (HCSUS) and 881 individuals from the Veterans Aging Cohort 3 Site Study (VACS 3). The authors compared the prevalence of eight symptoms common to both studies and 10 symptoms examined only in the VACS 3 population, stratified by age and race. Disease severity was assessed by CD4 count and 18 HIV-related diseases reported. Multivariate logistic regression models were used to account for demographics and severity differences. VACS 3 versus HCSUS participants were more likely nonwhite and older. In unadjusted comparisons, older nonwhites were less likely to report experiencing symptoms than younger whites. They reported the fewest total number of symptoms and the fewest individual symptoms common to both studies (headache, fever, nausea/vomiting, and diarrhea) or in the VACS 3 only (dizziness, sleeping difficulty, fatigue, rashes, bloating, and myalgias/arthalgias). Multivariate regression estimates suggest older age predicts a greater likelihood of reporting peripheral neuropathy, weight loss, or hair loss, but a lower likelihood of reporting headaches, depressed mood, white oral patches, or diarrhea. Nonwhites appeared less likely to report symptoms. Age is a determinant of reporting certain symptoms in HIV disease but may be masked or accentuated by other factors such as race.
authors.affiliation: Division of General Internal Medicine and Health Services Research, University of Southern California at Los Angeles, 90095-1736, USA. dzingmond@mednet.ucla.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Zingmond
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
authors.forename: Maria
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.forename: Dennis
authors.initials: D
authors.lastname: Taub
authors.forename: Sharon
authors.initials: S
authors.lastname: Weissman
authors.forename: Janet
authors.initials: J
authors.lastname: Briggs
authors.forename: Joseph
authors.initials: J
authors.lastname: Wagner
authors.forename: Susan
authors.initials: S
authors.lastname: Smola
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Bozzette
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006679:HIV Seropositivity / Q000145:classification / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D007182:Income; D007348:Insurance, Health; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*