Prevalence of pain in women living with HIV aged 45–60: associated factors and impact on patient-reported outcomes

ABSTRACT

As the population of women with HIV ages, an increasing proportion are experiencing the menopause, with potential associated pain. Among 844 participants in the Positive Transitions Through the Menopause (PRIME) study (72.3% black African; median age 49 (interquartile-range 47–53) years; 20.9%, 44.0% and 35.1% pre-, peri- and post-menopausal), 376 (44.6%) and 73 (8.7%) reported moderate or extreme pain. Women had been diagnosed with HIV for 14 (9–18) years, 97.7% were receiving antiretroviral therapy and 88.4% had a suppressed viral load. In adjusted ordinal logistic regression, peri-menopausal status (adjusted odds ratio (1.80) [95% confidence interval 1.22–2.67]), current smoking (1.85 [1.11–3.09]), number of comorbid conditions (1.95 [1.64–2.33] /condition) and longer duration of HIV (1.12 [1.00–1.24]/5 years) were independently associated with increased reported pain, whereas being in full-time work (0.61 [0.45–0.83]) and having enough money for basic needs (0.47 [0.34–0.64]) were associated with decreased pain reporting. Increasing pain was independently related to insomnia symptoms (moderate: 2.76 [1.96–3.90]; extreme: 8.09 [4.03–16.24]) and severe depressive symptoms (PHQ4 ≥ 6; moderate: 3.96 [2.50–6.28]; extreme: 9.13 [4.45–18.72]). Whilst our analyses cannot determine the direction of any associations, our findings point to the importance of eliciting a history of pain and addressing symptoms in order to improve wellbeing.

KEYWORDS:

• HIV
• menopause
• pain
• predictors
• insomnia
• depression

Acknowledgements

We would like to thank the PRIME Study Expert Advisory Group: Comfort Adams, Jane Anderson, Mwenza Blell, Jonathan Elford (Chair), Janine MacGregor-Read, Fiona Pettitt, Janice Rymer, Jane Shepherd, Lorraine Sherr and Emily Wandolo; and the PRIME Study recruiting sites: Barking Community Hospital (Rageshri Dhairyawan, Emma Macfarlane, Sharmin Obeyesekera, Cecelia Theodore); Barts Hospital NHS Trust (James Hand, Helena Miras, Liat Sarner); Brighton and Sussex University Hospital (Yvonne Gilleece, Alyson Knott, Celia Richardson); Chelsea and Westminster Hospital (Mimi Chirwa, Ann Sullivan, Mini Thankachen, Sathya Visvendra); City of Coventry Health Centre (Sris Allen, Kerry Flahive); Guy’s and St Thomas’ Hospital (Julie Fox, Julianne Iwanga, Annemiek DeRuiter, Mark Taylor); 10 Hammersmith Broadway (Sophie Hobday, Rachael Jones, Clare Turvey); Homerton University Hospital (Monica James, Sambasivarao Pelluri, Iain Reeves); Kings College Hospital (Sarah Barber, Priya Bhagwandin, Lucy Campbell, Leigh McQueen, Frank Post, Selin Yurdakul, Beverley White); Lewisham and Greenwich NHS Trust (Tarik Moussaoui, Melanie Rosenvinge, Judith Russell); Mortimer Market Centre (Tuhina Bhattacharya, Alexandra Rolland, Shema Tariq); New Cross Hospital Wolverhampton (Sarah Milgate, Anjum Tariq); North Manchester General Hospital (Claire Fox, Gabriella Lindergard, Andrew Ustianowski); Royal Free London NHS Foundation Trust (Fiona Burns, Nargis Hemat, Nnenna Ngwu, Rimi Shah); Southend Hospital (Sabri Abubakar, John Day, Laura Hilton, Henna Jaleel, Tina Penn); St Mary’s Hospital (Angela Bailey, Nicola Mackie); University Hospital Birmingham (Reka Drotosne-Szatmari, Jan Harding, Satwant Kaur, Tessa Lawrence, Monika Oriak, Jonathan Ross); and West Middlesex Hospital (Kimberley Forbes, Ursula Kirwan, Shamela De Silva, Marie-Louise Svensson, Rebecca Wilkins). We are grateful for support from Positively UK and the UK-CAB. Finally, and most importantly, we thank all our participants for sharing their time and experiences so generously with us.

The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Wellcome Trust, or the Department of Health and Social Care.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Declaration of interests

CS has received funding for participation in Advisory Boards and for preparation of educational materials from Gilead Sciences and ViiV Healthcare. ST has previously received a travel bursary funded by Janssen-Cilag through the British HIV Association, and speaker honoraria and funding for preparation of educational materials from Gilead Sciences. RD has received funding for participation in Advisory boards from Gilead Sciences and speaker honoraria from Gilead Sciences, ViiV Healthcare and Janssen-Cilag. FB has received speaker and consultancy fees from Gilead Sciences.

Additional information

Funding

The PRIME Study was funded by the National Institute for Health Research (NIHR) in the form of a postdoctoral fellowship to ST [PDF-2014-07-071]. Between March and December 2018 ST received salary support to continue work on this study, through a UCL/Wellcome Institutional Strategic Support Fund Flexible Support Award [204841/Z/16/Z].