Kowalski Marcin, Horban Andrzej, Slomka Bartosz, Shahnazaryan Karen, Rongies Witold
Polish Medical Air Rescue, Clinical Governance Department, Warsaw, Poland.
Department of Adults' Infectious Diseases, Medical Faculty, Medical University of Warsaw, Warsaw, Poland.
BMC Infect Dis. 2021 Feb 1;21(1):136. doi: 10.1186/s12879-021-05776-7.
Chronic pain in HIV-infected patients on effective antiretroviral therapy (ART) limits patients' normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. Therefore we analyzed the frequency and factors associated with chronic pain in HIV-infected patients on ART.
We conducted a prospective, survey study, including consecutive HIV-infected patients under specialist care at the HIV Outpatient Clinic of the Hospital for Infectious Disease in Warsaw between February 2014 and December 2016. During their routine visit all patients who agreed to participate in the study were surveyed using a study questionnaire. For all patients reporting any pain the Brief Pain Inventory (BPI) form and Douleur Neuropathique 4 Questions form (DN4) were completed. Data on history and current ART and laboratory measurements were obtained from electronical database. Chi-squared and Kruskal-Wallis tests were used for group comparison. The potential factors associated with chronic pain were identified via logistic regression models.
In total 196 HIV-infected patients were included in the study, 57 (29,1%) of them reported chronic pain. The reported pain was mostly (75%) limited to a single area of the body. In univariable logistic regression model the odds of chronic pain were significantly higher with increasing age (OR 1.36 [95%CI:1.17-1.58]), time under specialist care (OR 2.25 [95%CI:1.42-35.7]), time on ART (OR2.96 [95%CI:1.60-5.49]), previous ART with zidovudine (OR 2.00[95%CI:1.06-1.55]) and previous treatment with ddI, ddC or d4T (OR4.13 [95%CI:1.92-8.91]). Homosexual route of HIV infection as compared to injecting drug use was decreasing the odds of chronic pain (OR0.33 [95%CI: 014-0.75]). In multivariable analyses, adjusting for all above the only factor associated with chronic pain was age (OR1.28 [95%CI:1.06-1.55]).
The prevalence of chronic pain in the studied population of HIV-infected Polish patients was high. The only risk factor for chronic pain identified was age. With ageing HIV population it is therefore imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.
接受有效抗逆转录病毒治疗（ART）的HIV感染患者的慢性疼痛在躯体和心理方面均限制了患者的正常功能。关于该主题的当前知识状态不足，这种疼痛的潜在原因尚不清楚。因此，我们分析了接受ART治疗的HIV感染患者中慢性疼痛的发生率及相关因素。
我们进行了一项前瞻性调查研究，纳入了2014年2月至2016年12月期间在华沙传染病医院HIV门诊接受专科护理的连续HIV感染患者。在他们的常规就诊期间，所有同意参与研究的患者都使用研究问卷进行了调查。对于所有报告有任何疼痛的患者，完成了简明疼痛问卷（BPI）表格和神经病理性疼痛4问题表格（DN4）。从电子数据库中获取了病史、当前ART治疗情况及实验室测量数据。采用卡方检验和Kruskal-Wallis检验进行组间比较。通过逻辑回归模型确定与慢性疼痛相关的潜在因素。
共有196例HIV感染患者纳入研究，其中57例（29.1%）报告有慢性疼痛。报告的疼痛大多（75%）局限于身体的单个部位。在单变量逻辑回归模型中，随着年龄增加（比值比[OR]1.36[95%置信区间：1.17 - 1.58]）、专科护理时间增加（OR 2.25[95%置信区间：1.42 - 3.57]）、ART治疗时间增加（OR 2.96[95%置信区间：1.60 - 5.49]）、既往使用齐多夫定进行ART治疗（OR 2.00[95%置信区间：1.06 - 1.55]）以及既往使用去羟肌苷、双脱氧胞苷或司他夫定治疗（OR 4.13[95%置信区间：1.92 - 8.91]），慢性疼痛的几率显著升高。与注射吸毒相比，HIV感染的同性恋途径降低了慢性疼痛的几率（OR 0.33[95%置信区间：0.14 - 0.75]）。在多变量分析中，对上述所有因素进行调整后，与慢性疼痛相关的唯一因素是年龄（OR 1.28[95%置信区间：1.06 - 1.55]）。
在接受研究的波兰HIV感染患者群体中，慢性疼痛的患病率较高。确定的慢性疼痛唯一风险因素是年龄。因此，随着HIV感染人群老龄化，为HIV专科治疗诊所、疼痛治疗诊所和康复单位制定合作方案势在必行。
