Pain in HIV infection and AIDS

Pain syndromes occurring in patients with HIV infection/AIDS vary in etiology and pathogenesis. According to the results of studies conducted to date, approximately 45% of patients have pain syndromes directly related to HIV infection or the consequences of immunodeficiency, 15-30% have pain syndromes related to therapy or diagnostic procedures, and the remaining 25% have pain syndromes that are not related to 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 reasons. Firstly, pain can be associated with immune changes caused by HIV, leading to the development of distal sensory polyneuropathy or, less often, myelopathy. Secondly, pain can be caused by toxic damage to the nervous system due to HIV therapy with specific antiretroviral drugs.

Distal sensory polyneuropathy develops in 30% of patients with HIV infection and manifests itself as spontaneous pain, paresthesia and dysesthesia in the cystic parts of the legs. It has been established 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. However, it is important to remember the possible toxic effect of drugs on peripheral nerves.

Opioids, antidepressants, neuroleptics, anticonvulsants and local anesthetics are used for symptomatic pain therapy in patients with HIV infection. The use of opioids is described in detail in the specialized literature. Of the 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 certain role as adjuvant drugs.

Carbamazepine, traditionally considered the drug of choice for some forms of neuropathic pain, should be used with caution in HIV infection (especially in the presence of thrombocytopenia, signs of spinal cord damage, and in patients who require careful monitoring of blood counts to determine the status of the disease). Gabapentin and lamotrigine are also used in the treatment of neuropathic pain, although in controlled studies their effectiveness did not exceed the placebo effect. In general, pain in polyneuropathy associated with HIV infection is poorly relieved by drugs effective in other neuropathic pain. 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 antiretroviral agents (ritonavir, saquinavir).

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

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