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Over Half in UK HIV Women's Study Report Moderate or Severe Pain
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HIV Drug Therapy/Glasgow 2020, October 5-8, 2020
Mark Mascolini
In a UK study of 844 HIV-positive women 45 to 60 years old, 45% reported moderate pain and 9% extreme pain [1]. Moderate pain and extreme pain each independently boosted odds of insomnia and depressive symptoms.
Researchers from University College London (UCL) and Barts Health NHS Trust noted that people with HIV often endure pain, which can readily affect quality of life. In particular, women going through the menopause widely report pain, the researchers reminded colleagues, but little is known about how often and why pain affects women with HIV, or about pain's consequences in women.
The UCL/NHS team sought to address these questions in 45- to 60-year-old women in the Positive Transitions Through the Menopause (PRIME) study [2,3], who completed questionnaires in 2016 and 2017. PRIME included 869 HIV-positive women who answered questions about mental and physical health. The researchers used ordinal regression models to explore associations between severity of pain and demographic, lifestyle, and clinical variables. Multivariable logistic regression assessed associations between pain and severe depressive symptoms (PHQ4 score above 6) and insomnia symptoms.
Among 844 women studied, 79% were black (mostly black African). In all, 85% were born outside the UK. Median age stood at 49 (interquartile range [IQR] 47 to 53. At the time of the study interview, 21% of women were premenopausal, 44% perimenopausal, and 35% postmenopausal. While 49% of women reported full-time employment, 37% sometimes or never had enough money to meet basic needs.
A large minority of women, 44.5%, reported moderate pain or discomfort, and 8.6% reported extreme pain or discomfort. Women experiencing severe pain were less likely to be working full-time, less likely to have enough money to meet basic needs, more likely to be current smokers, and more likely to be perimenopausal or postmenopausal.
Median number of medical conditions reported rose from 0 in women with no pain or discomfort, to 1 in women with moderate pain, and to 2 in those with extreme pain. Women with moderate or extreme pain had HIV infection longer, and those with extreme pain were less likely to claim good antiretroviral adherence. Latest CD4 count and viral load were not associated with moderate or extreme pain.
Four factors independently predicted more severe pain: More medical conditions, current smoking, perimenopausal (versus premenopausal) status, and longer HIV duration. The same multivariable ordinal regression analysis independently linked full-time employment and having enough money for basic needs to decreased pain.
While 40% of women reported insomnia symptoms, 25% reported severe depressive symptoms. In adjusted analysis, women with moderate pain (versus no pain) had nearly 3-fold higher odds of insomnia symptoms (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 1.96 to 3.90) and 4-fold higher odds of severe depressive symptoms (aOR 3.96, 95% CI 2.50 to 6.28). Women with extreme pain (versus no pain) had 8-fold higher odds of insomnia symptoms (aOR 8.09, 95% CI 4.03 to 16.24) and 9-fold higher odds of depressive symptoms (aOR 9.13, 95% CI 4.45 to 18.72).
PRIME study researchers believe their findings underline the importance to asking women with HIV about pain and addressing symptoms of pain in women who have them.
References
1. Sabin CA, Okhai H, Dhairyawan R, et al. Prevalence of pain in women living with HIV aged 45-60: associated factors and impact on patient-reported outcomes. HIV Drug Therapy/Glasgow 2020, October 5-8, 2020. Abstract P062.
2. UK-PRIME Study, Menopause in Women Living with HIV in the UK. https://hivoutcomes.eu/case_study/uk-prime-study-menopause-in-women-living-with-hiv-in-the-uk/
3. Tariq S, Burns FM, Gilson R, Sabin C. PRIME (Positive Transitions Through the Menopause) study: a protocol for a mixed-methods study investigating the impact of the menopause on the health and well-being of women living with HIV in England. BMJ Open. 2019; 9(6):e025497. doi: 10.1136/bmjopen-2018-025497
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