Pain and Physical/Psychological Symptoms in Ambulatory Patients with HIV (317-B)

Abstract

1.Describe the prevalence and of pain and physical/psychological symptoms in a population of ambulatory HIV patients.2.Recognize HIV as a disease in which pain is associated with history of psychiatric illness and IV drug use, but not with markers of HIV disease such as CD4 and viral load. Background. HIV has become a manageable chronic disease. There are few studies of pain and symptoms in the current treatment era, when most patients are virologically suppressed. Research objectives. Determine the prevalence of and risk factors for pain and physical and psychological symptoms in a population of ambulatory HIV patients. Methods. Cross-sectional sectional study using the Brief Pain Inventory and Memorial Symptom Assessment Scale. Results. We evaluated 156 individuals with a median age of 53.5 years (range 21-71 years), median time since HIV diagnosis of 11 years (range < 1-25 years), and median CD4 count of 502 cells/mm3 (interquartile range 308-683). The majority (125, 80.6%) had an undetectable viral load. Seventy-six (48.7%) reported pain, of whom 39 (51.3%) had moderate to severe pain, and 43 (57.3%) reported that the pain caused moderate to severe interference with their lives. The median number of symptoms was 8 (interquartile range 5-14.5) out of 32. The most common physical symptoms were lack of energy (89, 57.1%) and numbness/tingling in the hands and feet (72, 46.2%). Sixty-one patients (39.1%) experienced high distress from three or more physical symptoms, and 74 (47%) experienced high distress from at least one psychological symptom. There was no relationship between pain severity and CD4 or viral load (p = 0.16 and 0.31, respectively), or number of symptoms and CD4 or viral load (p = 0.21, p = 0.2, respectively). Patients with psychiatric illness were more likely to report pain than patients without [37/52 (71.2%) vs. 39/104 (37.9%), p < 0.001], and the presence of pain was correlated with more psychological symptoms (p = 0.002). Conclusion. Pain and other physical and psychological symptoms are common among ambulatory HIV patients. Pain was not related to markers of HIV disease, but rather with intravenous drug use (IDU) and psychiatric history. Implications for research, policy, or practice. Future investigation should identify barriers to achieving pain and symptom control, and the impact of pain and symptoms on quality of life and adherence. Physical Aspects of Care; Psychological and Psychiatric Aspects of Care