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Current Pain Risk Higher in Older HIV+ Group vs Older HIV- and Younger HIV+
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16th European AIDS Conference, October 25-27, 2017. Milan
Mark Mascolini
Among HIV-positive and negative people 50 or older, those with HIV had higher odds of current pain, according to analysis of the England-Ireland POPPY cohort [1]. Older people with HIV also ran a higher risk of current pain than a younger HIV group. Older HIV-negative people saw a clinician for pain more often than either HIV group.
Pain remains a frequent complaint among people with HIV. But POPPY investigators pointed out that little research explores pain rates and consequences in the current antiretroviral era, especially in aging people with HIV. They conducted this comparison of pain prevalence in the three groups recruited for POPPY: (1) people 50 or older who acquired HIV sexually, (2) younger people who acquired HIV sexually who are frequency-matched to the older group on gender, ethnicity, sexuality, and location (in or out of London), and (3) HIV-negative people 50 or older matched to the older HIV group on age and the other just-mentioned factors.
POPPY participants in this analysis completed a questionnaire on aches and pains in the past month, current pain, days missed from work because of pain, and seeing a clinician because of pain. Researchers also collected pain-related information from medical records of these cohort members. Participants completed a quality-of-life questionnaire (SF-36) and two depression questionnaires (CES-D and PHQ-9). POPPY investigators explored associations between HIV and current pain through logistic regression models before and after adjustment for gender, sexuality, race, educational level, and body mass index.
The study included 676 people in the older HIV group, 357 in the younger HIV group, and 292 in the older HIV-negative group. Respective proportions of women were 11.8%, 18.8%, and 35.3%, of men who have sex with men 79.3%, 72.8%, and 47.6%, and of blacks 12.9%, 19.3%, and 9.6%. Median ages of the older HIV group, younger HIV group, and HIV-negative group were 57, 43, and 58. Almost all HIV-positive people were taking antiretroviral therapy.
Pain during the past month was significantly more frequent in the older HIV group (70%) than in the younger HIV group (62.7%) or the older HIV-negative group (64.4%) (P = 0.03). Current pain was also more frequent in the older HIV group (48.8%) than the younger HIV group (37.5%), or the older HIV-negative group (43.8%).
A marginally lower proportion of older than younger people with HIV missed work because of pain (6.3% versus 7.6%), perhaps because the older group had a lower proportion of workers or learned to live with their pain. Both HIV groups missed work because of pain more often than the older HIV-negative group (4.9%). A slightly but significantly higher proportion of the HIV-negative group than either HIV group saw a general practitioner because of pain (P = 0.005), perhaps because people with HIV had grown accustomed to pain, did not think it could be remedied, or felt they had more urgent health questions to address. Analgesic use was slightly but significantly higher in the older HIV group than in the other two groups (P = 0.001).
Logistic regression analysis determined that younger people with HIV and older people without HIV had about 40% lower odds of current pain than older people with HIV. These associations changed little after adjustment for gender, sexuality, race, education, and body mass index when comparing the older HIV group with either of the other two groups. Additional adjustment for age did not affect the association when comparing the older HIV group with the older HIV-negative group.
HIV-positive people with versus without current pain had significantly worse depression scores on both CES-D and PHQ-9, regardless of age. On the CES-D, for example, median scores were 15 versus 11 with versus without current pain in the older HIV group (P = 0.009) and 14 versus 9 with versus without current pain in the younger HIV group (P = 0.006). Similarly, in both age groups HIV-positive people with versus without current pain had significantly worse quality-of-life scores in nearly all of 7 SF-36 domains.
POPPY researchers cautioned that the cross-sectional design of this analysis limits conclusions about causality. But they believe their findings "support the need for routine assessment of pain" in people with HIV. They added that further longitudinal studies focused on pain severity, location, and contributors could point to effective pain interventions.
Reference
1. Sabin C, Bagkeris E, Nkhoma K, et al. High prevalence and burden of pain in people living with HIV (PLWH): the POPPY study. 16th European AIDS Conference. October 25-27, 2017. Milan. Abstract PE11/39.
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