Psychosocial factors associated with persistent pain in people with HIV: A systematic review with meta-analysis

Chronic pain remains a prevalent and disabling problem for people living with the human immunodeficiency virus (HIV) in the current antiretroviral (ART) treatment era. Psychosocial treatments may have promise for managing the impact of this pain. However, research is needed to identify psychosocial processes to target through such treatments. The current systematic review and meta-analysis examined the evidence for psychosocial factors associated with pain, disability, and quality of life in people living with HIV and persistent pain. Observational and experimental studies reporting on the association between one or more psychosocial factor and one or more pain-related variable in an adult sample of people living with HIV and pain were eligible. Two reviewers independently conducted eligibility screening, data extraction, and quality assessment. Forty-six studies were included in the review and 37 of these provided data for meta-analyses (12493 participants). ‘Some’ or ‘moderate’ evidence supported an association between pain outcomes in people with HIV and the following psychosocial factors: depression, psychological distress, post-traumatic stress, drug abuse, sleep disturbance, reduced ART adherence, healthcare use, missed HIV clinic visits, unemployment, and protective psychological factors. Surprisingly few studies examined protective psychological factors or social processes, such as stigma. There were few high quality studies. These findings can inform future research and psychosocial treatment development in this area. Greater theoretical and empirical focus is needed to examine the role of protective factors and social processes on pain outcomes in this context. The review protocol was registered with PROSPERO (CRD42016036329).This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

• Determinants of Health
  • Employment
  • Social support
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Substance Use
  • Alcohol
  • Nonmedicinal drugs
• Mental Health
  • Depression
  • Psychiatric disorders