Institute for Global Health, UCL.
Florence Nightingale Faculty, Cicely Saunders Institute, Kings College London.
AIDS. 2018 Nov 28;32(18):2697-2706. doi: 10.1097/QAD.0000000000002021.
We describe the prevalence of pain and its associations with healthcare resource utilization and quality-of-life.
The POPPY Study recruited three cohorts: older people living with HIV (PLWH; ≥50 years, n = 699), younger demographically/lifestyle similar PLWH (less than 50 years, n = 374) and older demographically/lifestyle similar HIV-negative (≥50 years, n = 304) people from April 2013 to February 2016.
Current pain and pain-related healthcare use was collected via a self-reported questionnaire. Logistic regression assessed between-group differences in the prevalence of pain in the past month and current pain after controlling for potential confounders. Associations between current pain and healthcare resource use, reported joint problems, depressive symptoms, quality-of-life and functional status were assessed in PLWH using Mann-Whitney U and chi-squared tests.
Pain in the past month was reported by 473 out of 676 (70.0%) older PLWH, 224 out of 357 (62.7%) younger PLWH and 188 out of 295 (63.7%) older HIV-negative controls (P = 0.03), with current pain reported in 330 (48.8%), 134 (37.5%) and 116 (39.3%), respectively (P = 0.0007). Older PLWH were more likely to experience current pain, even after adjustment for confounders. Of those with pain in the past month, 56 out of 412 (13.6%) had missed days of work or study due to pain, and 520 (59%) had seen a doctor about their pain. PLWH experiencing current pain had more depressive symptoms, poorer quality-of-life on all domains and greater functional impairment, regardless of age group.
Even in the effective antiretroviral therapy era, pain remains common in PLWH and has a major impact on quality-of-life and associated healthcare and societal costs. Interventions are required to assist clinicians and PLWH to proactively manage pain.
我们描述了疼痛的流行情况及其与医疗资源利用和生活质量的关系。
POPPY 研究招募了三个队列：年龄较大的 HIV 感染者（PLWH；≥50 岁，n=699）、年龄较小的具有相似人口统计学/生活方式的 PLWH（<50 岁，n=374）和年龄较大的具有相似人口统计学/生活方式的 HIV 阴性者（≥50 岁，n=304），从 2013 年 4 月至 2016 年 2 月。
通过自我报告问卷收集当前疼痛和与疼痛相关的医疗保健使用情况。使用逻辑回归在控制潜在混杂因素后，评估过去一个月内疼痛的发生率和当前疼痛在不同组间的差异。使用 Mann-Whitney U 和卡方检验评估 PLWH 中当前疼痛与医疗资源利用、报告的关节问题、抑郁症状、生活质量和功能状态之间的关系。
在 676 名年龄较大的 PLWH 中，有 473 名（70.0%）报告过去一个月有疼痛，在 357 名年龄较小的 PLWH 中，有 224 名（62.7%）报告有疼痛，在 295 名年龄较大的 HIV 阴性对照者中，有 188 名（63.7%）报告有疼痛（P=0.03），分别有 330 名（48.8%）、134 名（37.5%）和 116 名（39.3%）报告当前有疼痛（P=0.0007）。即使在调整了混杂因素后，年龄较大的 PLWH 更有可能经历当前的疼痛。在过去一个月有疼痛的患者中，有 56 名（13.6%）因疼痛而缺勤或缺课，有 520 名（59%）因疼痛看医生。有当前疼痛的 PLWH 抑郁症状更严重，所有领域的生活质量更差，功能障碍更严重，而不论年龄组如何。
即使在有效的抗逆转录病毒治疗时代，疼痛仍然是 PLWH 的常见问题，对生活质量和相关的医疗保健及社会成本有重大影响。需要采取干预措施来帮助临床医生和 PLWH 主动管理疼痛。
