Upper and lower gastrointestinal symptoms in HIV-infected adults in a clinical cohort in Midwestern Brazil: incidence and associated factors

Abstract

Aim : The present study aimed to investigate the incidence of both upper and lower gastrointestinal symptoms and associated factors in HIV-infected adults with or without antiretroviral therapy (ART). Methodology : This study is part of a clinical cohort conducted with adult HIV-infected adults in Midwestern Brazil on outpatient care. Outcome variables were the presence of upper (nausea/vomiting, dyspepsia, and heartburn) and lower (diarrhea, constipation, and flatulence) gastrointestinal symptoms incident on the week before data collection. Explanatory variables were sex, tobacco use, nutritional status, waist circumference (WC), duration of ART, protease inhibitors (PI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) use, and CD4+ T lymphocyte count. The estimate of the effect was analyzed by the incidence ratio (IR) and 95% confidence interval (CI). Statistical significance level was set at p<0.05. Results : Of 290 study participants, 69.0% were on ART. The most incident gastrointestinal symptom was heartburn (49.3%), followed by flatulence (43.4%), dyspepsia (24.5%), nausea/vomiting (22.8), diarrhea (18.3%), and constipation (16.2%). No difference was observed in the incidence of gastrointestinal symptoms in participants with or without ART. The associated factors with upper and/or lower gastrointestinal symptoms were female sex, excess of body weight, abdominal obesity, less than one year of ART use, tobacco exposure, and CD4+ T lymphocyte count. Conclusion : A high incidence of several gastrointestinal symptoms was found in HIV-infected adults, associated with both modifiable and non-modifiable risk factors. These findings contribute to gastrointestinal symptoms management in clinical practice for people living with HIV/AIDS, mainly those in risk categories, as gastrointestinal symptoms could result in adverse outcomes for this population.