The effect of concomitant fibromyalgia in HIV infected patients receiving antiretroviral therapy: a prospective cross-sectional study

Abstract

BackgroundHIV infected patients receiving antiretroviral therapy (ART) have extensive musculoskeletal system involvement. Arthralgia and myalgia are the most common forms. Fibromyalgia Syndrome (FMS) is a chronic pain syndrome of the musculoskeletal system characterized by diffuse pain including arthralgia and myalgia. These overlapping symptoms are suggested the relationship between HIV and FMS. The primary purpose of this study was to determine the prevalence of FMS in HIV/AIDS patients. The secondary objective was to investigate the effects of FMS on functional status, depression, fatigue, sleep pattern and quality of life.MethodsA total of 225 HIV infected patients who were receiving ART were included in this cross-sectional prospective study. The demographic data of the participants, CD4 T-lymphocyte count (cells/mm3), viral load (> 40 copy/ml), and ART regimens were recorded. FMS diagnosis was based on 2016 revision of diagnostic criteria. All patients completed the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and SF-36 scale.ResultsFMS was found in 20% of the HIV infected patients (n = 45). The mean duration of disease was 4.74 ± 4.42 years; it was significantly longer in patients with FMS (p = 0.007). The median CD4 T-lymphocyte count was found to be 616.00 ± 303.91 cells/mm3, and it was significantly higher in patients without FMS (p = 0.06). No statistically significant difference was found between the two groups according to the drug regimens used. A statistically significant difference was found in FIQ, BDI, PSQI, FSS and all subgroups of the SF-36 scale between the patients with and without FMS (p = 0.001).ConclusionsA slightly higher frequency of FMS was determined in HIV infected patients receiving ART compared to previous studies. It was shown that presence of FMS negatively affected the function, depression, fatigue, sleep, and quality of life. Detection of FMS may decrease depression, fatigue, and sleep disorders and increase the quality of life in HIV infected patients. FMS should be distinguished correctly for an accurate treatment management of HIV and for increasing ART compliance.

People living with HIV and the emerging field of chronic pain—what is known about epidemiology, etiology, and management

“…Non-neuropathic pain in PLWH can present in many different ways, including chronic low back pain, osteoarthritis, and multi-site pain [13,54,55]. In some cohorts, musculoskeletal pain is more common than neuropathic pain [13].…”

“…Non-neuropathic pain in PLWH is poorly studied. Musculoskeletal pain is common in multiple different cohorts of PLWH [13,55,56]. The etiologies of non-neuropathic pain in PLWH are disparate.…”

“…The etiologies of non-neuropathic pain in PLWH are disparate. Some are specific to HIV, such as avascular necrosis and osteoporosis with subsequent fracture [57], while others are less specific to HIV such as lumbosacral pain [13] and fibromyalgia [55]. In cohorts of patients with multi-site and non-neuropathic pain, elevated inflammatory cytokines were associated with increasing age and with worsening measures of chronic pain [52,53].…”