Pain in HIV infection and AIDS

Pain syndromes that occur in patients with HIV / AIDS are different in etiology and pathogenesis. According to the results of studies conducted to date, approximately 45% of patients have painful syndromes directly associated with HIV infection or immunodeficiency, 15-30% with ongoing therapy or diagnostic procedures, and the remaining 25% are not associated with HIV infection or specific therapy.

Neuropathic pain is detected in HIV-infected patients in 46% of cases, it can be caused by two groups of causes. First, pain can be associated with immune changes caused by HIV, leading to the development of distal sensory polyneuropathy or, more rarely, myelopathy. Secondly, the pain can be caused by toxic damage to the nervous system due to the treatment of HIV infection with specific antiretroviral drugs.

Distal sensory polyneuropathy develops in 30% of patients with HIV infection and is manifested by spontaneous pain, paresthesia and dysesthesia in the cystal parts of the legs. It was found that the severity of polyneuropathy correlates with the HIV titer in the blood. This indicates that adequate antiretroviral therapy can have a positive effect in terms of treatment and prevention of pain syndrome. Nevertheless, it is important to remember the possible toxic effects of drugs on the peripheral nerves.

For symptomatic therapy of pain in patients with HIV infection, use of zioids, antidepressants, antipsychotics, anticonvulsants and local anesthetics. The use of opioids is described in detail in the literature. Of antidepressants, amitriptyline, imipramine, etc. Are most often prescribed (although their effectiveness has not been confirmed in clinical studies). Neuroleptics, such as fluphenazine, haloperidol, etc., can also play a role as adjuvant drugs.

Carbamazepine, traditionally considered as a drug of choice in certain forms of neuropathic pain, with HIV infection should be used with caution (especially in the presence of thrombocytopenia, signs of spinal cord injury, as well as in patients who need careful monitoring of blood indicators to determine the status of the disease). In the treatment of neuropathic pain, gabapentin, lamotrigine, is also used, although in controlled studies their efficacy did not exceed the placebo effect. In general, pain associated with polyneuropathy associated with HIV infection is poorly controlled by drugs that are effective for other neuropathic pains. When prescribing these drugs as adjuvant therapy, it is important to remember about drug interactions. In particular, opioid analgesics, antidepressants and anticonvulsants can interact with antiretrovirals (ritonavir, saquinavir).

In the treatment of pain in HIV infection, non-drug methods of treatment (physiotherapy, percutaneous electrical stimulation of nerves, psychotherapy, etc.) can also be useful.

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