What is the management approach for joint pain in patients with Human Immunodeficiency Virus (HIV)?

From the Guidelines

The management of joint pain in HIV patients should prioritize a comprehensive approach, including optimizing antiretroviral therapy (ART), using non-pharmacological methods like cognitive behavioral therapy (CBT) and physical therapy, and considering pharmacological options like acetaminophen or NSAIDs, as recommended by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1. The initial evaluation should determine if pain is related to HIV infection itself, medication side effects, or comorbid conditions.

• Key considerations include:
  • Optimizing ART to achieve viral suppression, which can improve symptoms
  • Using CBT to promote patient acceptance of responsibility for change and the development of adaptive behaviors
  • Considering physical therapy, weight management, and exercise as important non-pharmacological approaches
  • Regular monitoring for medication side effects, particularly when using NSAIDs or DMARDs in patients with compromised immune function For HIV-related arthralgia, first-line treatment typically includes acetaminophen (up to 3000mg daily in divided doses) or NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily), with careful monitoring for renal function and drug interactions with ART, as suggested by the guideline 1.
• Additional recommendations from the guideline include:
  • Developing and participating in interdisciplinary teams to care for patients with complex chronic pain 1
  • Addressing changes in pain experience as patients age and develop other age-related and HIV-related comorbidities 1
  • Engaging in frequent communication with the patient and their support system to maintain pain control and address goals of care 1

From the Research

Management Approach for Joint Pain in HIV Patients

The management of joint pain in patients with Human Immunodeficiency Virus (HIV) involves several challenges, including difficulties in assessing disease activity and limited information on the safety of immunosuppressive drugs 2.

Therapeutic Options

• The therapeutic options for inflammatory articular syndromes associated with HIV infection include disease-modifying antirheumatic drugs and anti-TNF agents 2.
• The management of chronic pain in patients living with HIV requires a comprehensive approach, taking into account the individual patient's circumstances and potential pharmacokinetic interactions 3.
• Antiretroviral therapy is a crucial component of HIV treatment and prevention, and updated recommendations from the IAS-USA Antiretroviral Guidelines Panel provide guidance on when to initiate therapy, recommended initial regimens, and special treatment considerations 4.

Considerations for Special Populations

• Patients with substance use and mental health disorders require special consideration in the management of chronic pain 3.
• The interface between antiretroviral therapy and opportunistic infections, as well as laboratory monitoring and adherence to antiretroviral therapy, are important factors to consider in the management of HIV patients with joint pain 4.

Clinical Characteristics

• Inflammatory articular syndromes associated with HIV infection include HIV-associated arthropathy, seronegative spondyloarthropathies, rheumatoid arthritis, and painful articular syndrome 2.
• Chronic pain is a common symptom in patients living with HIV, and its management requires a multidisciplinary approach 3.