Increasing Age Linked to Higher Risk of Chronic Pain in HIV

girl holding head in pain
girl holding head in pain
The purpose of this study was to ascertain the prevalence of chronic pain in the HIV-infected population which is under continuous specialist care, as well as to determine the underlying causative factors of such pain.

Age, rather than the use of antiretroviral therapy (ART), represents a significant factor involved in the development of chronic pain in patients with HIV, according to a study in BMC Infectious Diseases.

This survey study enrolled 196 consecutive patients with HIV (median age, 41.1 years) who were receiving specialist care at an HIV outpatient clinic in Poland from 2014 to 2016. All patients who reported chronic pain (n=57) completed the Brief Pain Inventory (BPI) form and Douleur Neuropathique 4 Questions form (DN4).

Researchers also collected data regarding history, current use of ART, and laboratory measurements from the electronic database. The investigators then conducted a logistic regression analysis to identify factors associated with the development of chronic pain in these patients.

Approximately 75.4% of pain reported by the patients was concentrated in a single region within the body. A univariable logistic regression analysis showed that the odds of chronic pain were significantly greater with increasing age (odds ratio [OR], 1.36; 95% CI, 1.17-1.58), time spent under specialist care (OR, 2.25; 95% CI, 1.42-35.7), time on ART (OR, 2.96; 95% CI, 1.60-5.49), previous ART with zidovudine (OR, 2.00; 95% CI, 1.06-1.55), as well as prior treatment with didanosine (ddI), zalcitabine (ddC), or stavudine (d4T; OR, 4.13; 95% CI, 1.92-8.91).

In contrast, HIV infection derived from homosexual intercourse was associated with decreasing odds of chronic pain compared with HIV infection derived from intravenous drug use (OR, 0.33; 95% CI, 0.14-0.75).

An adjusted multivariable analysis found that age was the only factor associated with the development of chronic pain in patients with HIV (OR per 5-year increase in age, 1.28; 95% CI, 1.06-1.55).

A limitation of this study was the lack of adjustment for potential factors affecting subjective assessments of pain, such as self-stigmatization.

The investigators concluded that given “the aging of the HIV-infected population,” it remains important “to develop standards for collaboration between specialist HIV treatment clinics and chronic pain treatment facilities as well as rehabilitation clinics and facilities.”


Kowalski M, Horban A, Slomka B, Shahnazaryan K, Rongies W. Is age and not antiretroviral therapy the strongest risk factor for chronic pain in HIV-infected population? BMC Infect Dis. 2021;21(1):136. doi:10.1186/s12879-021-05776-7