Chronic Pain in a Modern Virally Suppressed HIV Cohort: Associations with Comorbidities Depression and Disability

Chronic pain (CP) is common among people with HIV (PWH), yet its prevalence and associated factors in those receiving modern, virally suppressive antiretroviral therapy (ART) are not well understood. This prospective observational study compared CP frequency and associated outcomes between PWH and people without HIV (PWoH). Participants (40 PWH, 23 PWoH) completed a questionnaire assessing daily pain lasting more than three months. Additional data included pain intensity, interference with daily activities, opioid use, and depressed mood (Beck Depression Inventory-II), as well as HIV clinical markers and comorbidities. Groups were demographically similar; all PWH were virally suppressed, with a median HIV duration of 30.6 years, nadir CD4 count of 300 cells/μL, and current CD4 count of 644 cells/μL. CP was significantly more frequent in PWH (60%) than in PWoH (22%; OR = 5.4 [1.67, 17.5]; p = 0.0028). Among PWH, CP was associated with greater daily activity interference, higher opioid use (38% vs. 6%), and increased neuropathic pain symptoms. PWH with CP also had higher BDI-II scores, indicating worse mood. These findings suggest that CP remains prevalent and disabling among PWH despite effective modern-day ART, underscoring the need for targeted pain assessment and management in this population.