Robbins Nathaniel M, Chaiklang Kanokporn, Supparatpinyo Khuanchai
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Antiinfect Agents. 2016;14(1):38-46. doi: 10.2174/2211352514666151119211107.
To determine if better antiretroviral (ARV) central nervous system (CNS) penetration is associated with reduced rates of chronic pain in people living with HIV (PLWH).
Chronic pain remains prevalent in PLWH despite widespread ARV use. Mechanisms underlying this prevalence remain unknown, though neuroinflammation from persistent CNS HIV infection and maladaptive plastic changes in the CNS have been implicated. Here we hypothesize that better CNS ARV penetration, measured using the CNS Penetration-Effectiveness (CPE) score, would decrease rates of chronic pain.
We interviewed 254 consecutive adults from an HIV clinic in Chiang Mai, Thailand. We collected data on demographics, HIV history, ARV use, and pain characteristics. Patients were evaluated for depression using a Thai two question Patient Health Questionnaire (PHQ-2). Modified CPE score was calculated using established methods and grouped a priori into "low CPE" (≤7, poor penetration) and "high CPE" (≥8, good penetration). CPE score was compared with chronic pain scores in SPSS using appropriate statistical tests. A relationship between CPE score and a positive depression screen was tested further using multivariable binary logistic models.
245 of 254 subjects were on ARVs. Complete ARV data was available for 235 patients. 137 of these 235 patients (58.3%) had a CPE score ≤7, and 98 (41.7%) had a score ≥8. 49 patients had chronic pain, and 9 had neuropathic pain. Low CPE score was not associated with chronic pain (p=0.64), neuropathic pain (p=0.56), or frequent pain (p=0.80), nor was it associated with the severity of reported "worst pain" or "average pain" in the last 24 hours (p=0.18 and 0.48, respectively). analysis revealed that higher CPE score was a significant independent risk factor for depression measured by a positive PHQ-2 screen [OR (95% CI) = 1.29 (1.04-1.61), p=0.02]. This relationship was mediated primarily by exposure to zidovudine.
CPE score is not associated with chronic pain in PLWH. analysis demonstrated that CPE score, and zidovudine exposure in particular, predicts a positive depression screen. Given the substantial morbidity associated with chronic pain and mood disorders in PLWH, additional studies to determine preventable and treatable factors are imperative.
确定更好的抗逆转录病毒（ARV）药物中枢神经系统（CNS）穿透性是否与人类免疫缺陷病毒（HIV）感染者（PLWH）慢性疼痛发生率降低相关。
尽管广泛使用ARV药物，但慢性疼痛在PLWH中仍然普遍存在。尽管持续性CNS HIV感染引起的神经炎症和CNS中的适应性不良可塑性变化被认为与这种普遍性有关，但其潜在机制仍不清楚。在此，我们假设使用CNS穿透有效性（CPE）评分衡量的更好的CNS ARV穿透性会降低慢性疼痛发生率。
我们采访了泰国清迈一家HIV诊所的254名连续就诊的成年人。我们收集了人口统计学、HIV病史、ARV药物使用情况和疼痛特征的数据。使用泰国版两题患者健康问卷（PHQ-2）对患者进行抑郁评估。使用既定方法计算改良CPE评分，并预先分为“低CPE”（≤7，穿透性差）和“高CPE”（≥8，穿透性好）。在SPSS中使用适当的统计检验将CPE评分与慢性疼痛评分进行比较。使用多变量二元逻辑模型进一步检验CPE评分与阳性抑郁筛查之间的关系。
254名受试者中有245人正在接受ARV治疗。235名患者有完整的ARV数据。这235名患者中有137人（58.3%）CPE评分为≤7，98人（41.7%）评分为≥8。49名患者有慢性疼痛，9名患者有神经性疼痛。低CPE评分与慢性疼痛（p=0.64）、神经性疼痛（p=0.56）或频繁疼痛（p=0.80）均无关，也与过去24小时内报告的“最严重疼痛”或“平均疼痛”的严重程度无关（分别为p=0.18和0.48）。分析显示，较高的CPE评分是PHQ-2筛查阳性所衡量的抑郁的显著独立危险因素[比值比（95%可信区间）=1.29（1.04-1.61），p=0.02]。这种关系主要由齐多夫定暴露介导。
CPE评分与PLWH的慢性疼痛无关。分析表明，CPE评分，尤其是齐多夫定暴露，可预测阳性抑郁筛查结果。鉴于PLWH中慢性疼痛和情绪障碍相关的高发病率，必须进行更多研究以确定可预防和可治疗的因素。
