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Pain in people living with HIV and its association with healthcare resource use, well being and functional status

Sabin, Caroline A.a; Harding, Richardb; Bagkeris, Emmanouila; Nkhoma, Kennedyb; Post, Frank A.c; Sachikonye, Memoryd; Boffito, Martae; Anderson, Janef; Mallon, Patrick W.G.g; Williams, Iana; Vera, Jaimeh,i; Johnson, Margaretj; Babalis, Daphnek; Winston, Alanl

doi: 10.1097/QAD.0000000000002021

Objective: We describe the prevalence of pain and its associations with healthcare resource utilization and quality-of-life.

Design: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

aInstitute for Global Health, UCL

bFlorence Nightingale Faculty, Cicely Saunders Institute, Kings College London

cCaldecot Centre, King's College Hospital

dUK Community Advisory Board (UK-CAB)

eSt. Stephen's Centre, Chelsea and Westminster Hospital

fHomerton University Hospital, London, UK

gHIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland

hElton John Centre, Brighton and Sussex University Hospital

iBrighton and Sussex Medical School, Brighton

jIan Charleson Day Centre, Royal Free NHS Trust

kImperial Clinical Trials Unit, Imperial College London

lSt. Mary's Hospital London, Imperial College Healthcare NHS Trust, London, UK.

Correspondence to Caroline A. Sabin, Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Tel: +207 7940500 x34752; e-mail:

Received 2 May, 2018

Accepted 31 July, 2018

Copyright © 2018 Wolters Kluwer Health, Inc.