Clinical and demographic variables related to pain in HIV-infected individuals treated with effective, combination antiretroviral therapy (cART)

Abstract

Objective: With widespread use of combination antiretroviral therapy (cART), this study tested the hypotheses that: 1) pain would be reported less frequently than in earlier studies; 2) pain would correlate less with markers of disease progression (declining cluster of differentiation 4 [CD4+] count), than with age; and 3) pain would be associated inversely with adherence to cART. Design: Retrospective data analysis. Setting: Outpatient center of a university teaching hospital. Patients: Forty-one consecutive human immunodeficiency virus (HIV)-infected persons receiving cART. Outcome Measures: Self-reported pain scale data were retrospectively gathered by their treating physician, along with data regarding gender, age, CD4+ count, self-reported cART adherence, and receipt of pain medication. In addition, data on pain location, duration, and etiology, and on specific cART agents utilized were available for 26 of these subjects. Blinded data were submitted to the investigator, and associations between self-reported pain scores and other variables were calculated. Results: Pain was less prevalent than reported prior to cART (39% vs 60-80%), and pain scale scores were lower (2.0 vs 7.4). Patients reporting more intense pain were more likely to be receiving medication for pain than those reporting less severe pain (87.5% vs 25.0%). Pain was transient in 73% patients and chronic in 27%. Pain scores did not differ by gender, nor did they correlate with adherence scores, disease progression, or age. No patients reported neuropathic pain. Conclusions: In this cohort treated with cART, pain was less prevalent and less likely to be associated with HIV disease progression or treatment than indicated by studies conducted prior to the widespread use of cART. © 2010 American Academy of Pain Medicine.