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Liu X, Tang SJ. Pathogenic mechanisms of human immunodeficiency virus (HIV)-associated pain. Mol Psychiatry 2023; 28:3613-3624. [PMID: 37857809 DOI: 10.1038/s41380-023-02294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Chronic pain is a prevalent neurological complication among individuals living with human immunodeficiency virus (PLHIV) in the post-combination antiretroviral therapy (cART) era. These individuals experience malfunction in various cellular and molecular pathways involved in pain transmission and modulation, including the neuropathology of the peripheral sensory neurons and neurodegeneration and neuroinflammation in the spinal dorsal horn. However, the underlying etiologies and mechanisms leading to pain pathogenesis are complex and not fully understood. In this review, we aim to summarize recent progress in this field. Specifically, we will begin by examining neuropathology in the pain pathways identified in PLHIV and discussing potential causes, including those directly related to HIV-1 infection and comorbidities, such as antiretroviral drug use. We will also explore findings from animal models that may provide insights into the molecular and cellular processes contributing to neuropathology and chronic pain associated with HIV infection. Emerging evidence suggests that viral proteins and/or antiretroviral drugs trigger a complex pathological cascade involving neurons, glia, and potentially non-neural cells, and that interactions between these cells play a critical role in the pathogenesis of HIV-associated pain.
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Affiliation(s)
- Xin Liu
- Stony Brook University Pain and Analgesia Research Center (SPARC), Stony Brook University, Stony Brook, 11794, NY, USA
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, 11794, NY, USA
| | - Shao-Jun Tang
- Stony Brook University Pain and Analgesia Research Center (SPARC), Stony Brook University, Stony Brook, 11794, NY, USA.
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, 11794, NY, USA.
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Povshedna T, Swann SA, Levy SLA, Campbell AR, Choinière M, Durand M, Price C, Gill P, Murray MCM, Côté HCF. Global Prevalence of Chronic Pain in Women with HIV: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad350. [PMID: 37547855 PMCID: PMC10404009 DOI: 10.1093/ofid/ofad350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023] Open
Abstract
Chronic pain is common among people with human immunodeficiency virus (HIV) and detrimental to quality of life and overall health. It is often underdiagnosed, undertreated, and frankly dismissed in women with HIV, despite growing evidence that it is highly prevalent in this population. Thus, we conducted a systematic review and meta-analysis to estimate the global prevalence of chronic pain in women with HIV. The full protocol can be found on PROSPERO (identifier CRD42022301145). Of the 2984 references identified in our search, 36 were included in the systematic review and 35 in the meta-analysis. The prevalence of chronic pain was 31.2% (95% confidence interval [CI], 24.6%-38.7%; I2 = 98% [95% CI, 97%-99%]; P < .0001). In this global assessment, we found a high prevalence of chronic pain among women with HIV, underscoring the importance of understanding the etiology of chronic pain, identifying effective treatments, and conducting regular assessments in clinical practice.
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Affiliation(s)
- Tetiana Povshedna
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shayda A Swann
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Sofia L A Levy
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amber R Campbell
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Madeleine Durand
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Colleen Price
- Canadian HIV/AIDS and Chronic Pain Society, Global Pain and HIV Task Force, Ottawa, Ontario, Canada
| | - Prubjot Gill
- Woodward Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Edwin S. H. Leong Healthy Aging Program, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
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St Clair-Sullivan N, Simmons K, Harding-Swale R, Levett T, Maddocks M, Roberts J, Trotman D, Yi D, Vera JH, Bristowe K. Frailty and frailty screening: A qualitative study to elicit perspectives of people living with HIV and their healthcare professionals. HIV Med 2022; 24:480-490. [PMID: 36229192 DOI: 10.1111/hiv.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES People living with HIV are an ageing population with an increasing prevalence of frailty. Management of frailty requires assessment, communication and information sharing with patients. However, evidence regarding the meaning of frailty for this population, and the acceptability of frailty screening, is limited. This study aimed to explore the perceptions of older people living with HIV and HIV professionals towards frailty and routine screening for frailty. METHODS Data collection consisted of in-depth individual qualitative interviews with older people living with HIV and focus groups with HIV professionals purposively sampled from outpatient HIV clinics in London and Brighton, UK. Verbatim pseudonymised transcripts were analysed using reflexive thematic analysis supported by NVivo. RESULTS A total of 45 people living with HIV were interviewed, and 12 HIV professionals participated in two focus groups. Frailty was described as a series of losses around mobility, social inclusion, independence and mental acuity, which could happen at any age. Regarding language, for people living with HIV, explicitly using the word frail was acceptable during screening when approached sensitively and alongside provision of information and support to slow the progression of frailty. However, HIV professionals described concerns about using the word frail for fear of causing distress or offence. CONCLUSION Professionals described frailty in terms of functional deficits, whereas people living with HIV described a loss of personhood. Although there is a clear desire among people living with HIV to be informed of their frailty status, approaching conversations about frailty with understanding and compassion is vital. To gain the most from the screening, it is essential that frailty status is shared alongside a clear plan of actionable steps in their care.
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Affiliation(s)
- Natalie St Clair-Sullivan
- Brighton and Sussex Medical School, Brighton, UK.,King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Richard Harding-Swale
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | - Daniel Trotman
- King's College Hospital NHS Foundation Trust, London, UK
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Jaime H Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
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Derry-Vick HM, Johnston CD, Brennan-Ing M, Burchett CO, Glesby N, Zhu YS, Siegler EL, Glesby MJ. Pain Is Associated With Depressive Symptoms, Inflammation, and Poorer Physical Function in Older Adults With HIV. Psychosom Med 2022; 84:957-965. [PMID: 35980785 PMCID: PMC9553263 DOI: 10.1097/psy.0000000000001119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE People living with HIV (PLWH) frequently experience pain, which often co-occurs with psychological symptoms and may impact functional outcomes. We investigated cross-sectional associations between pain, depressive symptoms, and inflammation, and then explored whether pain was related to poorer physical function among older PLWH. METHODS We examined data from PLWH aged 54 to 78 years ( n = 162) recruited from a single outpatient program for a larger study on HIV and aging. Participants reported depressive symptoms (10-item Center for Epidemiological Studies Depression Scale) and then attended a biomedical visit in which they reported past-month pain (Medical Outcomes Study-HIV pain subscale), completed physical function assessments, and provided blood samples (assayed for interleukin 6, interferon-γ, tumor necrosis factor α, and C-reactive protein). Links between pain, depressive symptoms, inflammation, and physical function were tested using linear regression models. RESULTS PLWH with greater depressive symptoms experienced more pain than did those with fewer depressive symptoms ( B = 1.31, SE = 0.28, p < .001), adjusting for age, sex, race, body mass index, smoking, disease burden, time since HIV diagnosis, and medication use. Higher composite cytokine levels were associated with worse pain ( B = 5.70, SE = 2.54, p = .027 in adjusted model). Poorer physical function indicators, including slower gait speed, weaker grip strength, recent falls, and prefrail or frail status, were observed among those with worse pain. Exploratory mediation analyses suggested that pain may partially explain links between depressive symptoms and several physical function outcomes. CONCLUSIONS Pain is a potential pathway linking depressive symptoms and inflammation to age-related health vulnerabilities among older PLWH; longitudinal investigation of this pattern is warranted. PLWH presenting with pain may benefit from multidisciplinary resources, including behavioral health and geriatric medicine approaches.
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Pinkston MM, Busch AM, Stein M, Baker J, Caviness C, Herman D, Weisberg R, Abrantes AM, Uebelacker LA. Improving functioning in HIV+ patients with chronic pain and comorbid depression: Protocol for a randomized clinical trial testing a collaborative behavioral health intervention based on behavioral activation. Contemp Clin Trials 2022; 119:106842. [PMID: 35777696 PMCID: PMC10739651 DOI: 10.1016/j.cct.2022.106842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Persons living with HIV (PWH) experience a disproportionate level of comorbid chronic pain and depression compared to individuals who do not have a diagnosis of HIV. Many PWH report pain that impairs daily function, is severe, and requires medical management. Depression alone is associated with HIV disease progression, medication non-adherence, and increased mortality. Given that numerous studies show that PWHs have chronic pain and depression despite pharmacologic treatment, there is a clear need for additional treatment modalities to address these conditions. DESIGN In this paper, we describe our protocol for a multisite, randomized controlled trial of the effectiveness of a collaborative behavioral intervention, called HIV-Pain and Sadness Support (HIVPASS), designed for PWH who endorse chronic pain and depressive symptoms, as compared to an attention matched Health Education (HE) condition. The HIVPASS intervention is based on Behavioral Activation and designed to target both pain and depression using an integrated model that promotes collaboration between HIV medical and psychological providers. SETTING AND METHODS We plan to (1) recruit PWH who endorse chronic pain and depression in three sites located in New England and the Midwestern United States and (2) compare our HIVPASS intervention to a full attention matched HE intervention with the primary outcome of pain interference, and secondary outcomes of depression, physical activity, HIV medication adherence, and health-related quality of life. Follow-up assessments will occur monthly for three months during the intervention phase and then during the post-intervention phase at months four, six, nine and twelve. CONCLUSIONS We provide descriptions of our protocol and interventions of our randomized controlled trial for comorbid chronic pain and depression in PWH. TRIAL REGISTRATION http://ClinicalTrials.govNCT02766751 https://clinicaltrials.gov/ct2/show/NCT02766751?term=stein%2C+michael&draw=2&rank=5.
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Affiliation(s)
- Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Physicians Group, The Miriam Hospital, Providence, RI, USA.
| | - Andrew M Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Department of Medicine, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Michael Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Jason Baker
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Department of Medicine, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Celeste Caviness
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Debra Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Risa Weisberg
- VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research, Butler Hospital, Providence, RI, USA
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Wadley AL, Parker R, Mukhuba VA, Ratshinanga A, Zwane Z, Kamerman PR. South African men and women living with HIV have similar distributions of pain sites. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35144458 PMCID: PMC8832001 DOI: 10.4102/phcfm.v14i1.3114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background No studies have investigated sex differences in the location and number of pain sites in people living with human immunodeficiency virus (HIV) (PLWH), despite evidence that women, in general, bear a greater burden of pain than men. Aim To determine sex differences in the location and number of pain sites, and whether there were demographic or disease-related differences in the number of pain sites. Setting South African tertiary hospital HIV clinics and a community healthcare centre Methods We conducted a retrospective analysis of records from South African PLWH who had pain. Results Of the 596 participant records, 19% were male (115/596) and the median number of pain sites for both sexes was 2 (interquartile range [IQR]: 1 to 3). Pain was most frequently experienced in the head (men: 12%, women: 38%), feet and ankles (men: 42%, women: 28%), abdomen (men = 19%, women = 28%) and chest (men = 20%, women = 20%). After correcting for multiple comparisons, males were less likely to experience headache than females (Fisher’s exact text, odds ratio [OR] = 0.23, 95% confidence interval [CI]: 0.12 – 0.42, p = 0.000). Pain at other body sites was experienced similarly between the sexes. There was no meaningful variation in the number of pain sites between the sexes (logistic regression, p = 0.157). Conclusion A similar location and number of pain sites were experienced by male and female South African PLWH. The locations of pain sites were different from previous reports, however, suggesting that research into pain in PLWH cannot necessarily be generalised across cultures.
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Affiliation(s)
- Antonia L Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Slawek DE. People living with HIV and the emerging field of chronic pain-what is known about epidemiology, etiology, and management. Curr HIV/AIDS Rep 2021; 18:436-442. [PMID: 34046859 DOI: 10.1007/s11904-021-00563-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Chronic pain is common in people living with HIV (PLWH). It causes significant disability and poor HIV outcomes. Despite this, little is understood about its etiology and management. RECENT FINDINGS Recent studies suggest that chronic pain in PLWH is caused by inflammation that persists despite viral load suppression. This coupled with central sensitization and psychosocial factors leads to chronic pain that is difficult to manage. PLWH with chronic pain often feel that their pain is incompletely treated, and yet there are few evidence-based options for the management of chronic pain in PLWH. Recent studies suggest that an approach pairing pharmacotherapy and nonpharmacologic therapy may address the complex nature of chronic in PLWH. Chronic pain in PLWH is common yet poorly understood. Further research is needed in order to better understand the etiology of chronic pain and its optimal management.
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Affiliation(s)
- Deepika E Slawek
- Department of Medicine, Montefiore Health System & Albert Einstein College of Medicine, Bronx, NY, USA.
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Mohan A, Tijmes S, Cohen J, Sherman EM, Eckardt P. Iatrogenic Cushing syndrome following lumbar medial branch block in a patient with HIV on ritonavir and darunavir. Pain Manag 2021; 11:381-387. [PMID: 33678012 DOI: 10.2217/pmt-2020-0101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We present a case report of a 62-year old female with HIV and chronic facetogenic back pain who underwent bilateral L3-L4 and L4-L5 medial branch nerve blocks using triamcinolone acetonide 80 mg. 2 weeks later she presented to the emergency department with acute anxiety/depression and was discharged with psychiatric follow-up. 2 weeks after this she presented to the outpatient HIV clinic with persistent uncontrolled depression alongside classic cushingoid features (e.g., buffalo hump, moon facies). She was diagnosed with iatrogenic Cushing syndrome caused by a drug-drug interaction between triamcinolone and ritonavir, a protease inhibitor and a CYP3A4 enzyme inhibitor. While the literature describes the interaction of ritonavir with intra-articular/intranasal/epidural triamcinolone, this is the first documented occurrence following a nerve block procedure. Symptoms resolved within 6 months alongside discontinuation of protease inhibitor therapy.
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Affiliation(s)
- Abhinav Mohan
- Department of Physical Medicine & Rehabilitation, Memorial Healthcare System, Hollywood, FL 33021, USA
| | - Steven Tijmes
- Department of Physical Medicine & Rehabilitation, Memorial Healthcare System, Hollywood, FL 33021, USA
| | - Jackson Cohen
- Department of Physical Medicine & Rehabilitation, Memorial Healthcare System, Hollywood, FL 33021, USA
| | - Elizabeth M Sherman
- Division of Infectious Disease, Memorial Healthcare System, Hollywood, FL 33021, USA.,Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Paula Eckardt
- Division of Infectious Disease, Memorial Healthcare System, Hollywood, FL 33021, USA
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