A global assessment found that there was a high prevalence of chronic pain in women living with HIV.
Chronic pain, which can affect adherence to medication, mobility, and quality of life, is prevalent in women who were diagnosed with HIV, according to a review published in Open Forum Infectious Diseases. The importance of finding the cause of the chronic pain and identifying the treatments is highlighted by this finding.
Chronic pain is among the comorbidities for people diagnosed with HIV. The reasons for chronic pain in HIV are likely multifactorial. This study aimed to assess the global prevalence of chronic pain in women diagnosed with HIV and also to identify any gaps in literature on the topic.
The authors noted that while there have been studies on the prevalence and risk factors for pain in people with HIV, none have focused on women, "even though data suggest that women in the general population experience a higher prevalence of chronic pain than men. This paucity of research is unsurprising given the general lack of women- centered clinical HIV research or study of comorbid disease among women with HIV; nevertheless, it is a stark omission in the literature."
The researchers used Medline, Embase, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection to search for studies for the review. Observational cross-sectional and cohort studies were eligible to be included whereas case-control and randomized controlled trials were excluded.
Studies that included prevalence of chronic pain in women aged 16 years and older who had HIV were also included. Pain that lasted for at least 3 months with at least 1 anatomic site or a diagnosis of a pain disorder was what was needed to get a chronic pain diagnosis. The primary outcome was the prevalence of chronic pain in women with HIV using a random-effects model.
There were 36 studies included in the systematic review and 35 in a meta-analysis, which included 19,966 participants overall. There were 22 countries and 5 continents represented in the data, of which 66.7% was from the last 10 years. Estimates of illicit substance abuse ranged from 8% to 77% in the 8 studies that reported it and estimates of alcohol use ranged from 6% to 83% in the 15 studies that reported it.
The pooled prevalence of chronic pain in the primary meta-analysis was 31.2% (95% CI, 24.6%-38.7%), with the lowest prevalence at 4.0% (95% CI, 3.5%-4.5%) and highest at 84.1% (95% CI, 79.9%-87.8%). There was a high degree of heterogeneity with an I2 score of 98% (95% CI, 97%-99%).
The subgroup analysis found a pooled prevalence estimate of 27.8% (95% CI, 19.7%-37.7%) for peripheral neuropathy subgroup. All other pain subtypes had a pooled prevalence of 37.3% (95% CI, 24.2%-52.5%). The subgroup analysis also found that prevalence of pain in high income countries (34.5%; 95% CI, 25.4%-44.9%) was similar to low and middle income countries (28.9%; 95% CI, 18.9%-41.4%).
There were 3 studies that reported prevalence of chronic pain between HIV and non-HIV patients. The first study reported a higher prevalence of chronic pain in women with HIV compared with those without (20.6% vs 14.0%). The other 2 found no statistically significant result.
There were some limitations to this study. There was a high level of heterogeneity between the articles due to how chronic pain is defined and measured in the different studies as well as the diversity of study samples and the type of exposure. A meta-regression could also not be performed due to the sample size, which meant that important confounders could not be accounted for. Some subgroup analyses could not be performed due to heterogeneity in data. Most of the studies were of moderate quality rather than high quality.
"Overall, our results suggest that chronic pain is highly prevalent among women with HIV and warrants regular assessment at healthcare visits," the authors concluded. "Several clinical tools exist to assess for the presence of chronic pain, as well as severity and subjective experiences, and should be used frequently."
Povshedna T, Swann SA, Levy SLA, et al. Global prevalence of chronic pain in women with HIV: a systematic review and meta-analysis. Open Forum Infect Dis. Published online July 15, 2023. doi:10.1093/ofid/ofad350