Chronic pain is common among women with HIV infection and should be regularly assessed at health care visits, according to study results published in Open Forum Infectious Diseases.

Researchers performed a systematic review and meta-analysis to investigate the global prevalence of chronic pain among women aged 16 years and older with HIV infection. This review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 Checklist. The term “women” was used to characterize persons who identify as women. Observational cross-sectional and cohort studies were eligible for inclusion, but case-control and randomized controlled trials were not included. Chronic pain was defined as either pain lasting at least 3 months in at least 1 anatomical site or diagnosis of a pain disorder. Articles published between 1983 and November 2022 were included in the analysis.

A total of 36 references were included in the systematic review and 35 in the meta-analysis, representing data from 19,966 participants. The analysis spanned 22 countries and 5 continents. The overall percentage of patients who used antiretroviral therapy (ART) ranged between 0% and 100%, though some studies included in the review were conducted in the pre-ART era.

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In the primary meta-analysis, the pooled prevalence of chronic pain was 31.2% (95% CI, 24.6-38.7), with the lowest prevalence reported at 4.0% and the highest at 84.1%. Of note, studies that included data on chronic pain prevalence had significant heterogeneity (I2 =98%).

The researchers performed a subgroup analysis to compare the prevalence of peripheral neuropathy with that of all other chronic pain types. The pooled prevalence of peripheral neuropathy was 27.8% (95% CI, 19.7-37.7; I2 =99%), whereas the pooled prevalence of all other chronic pain types was 37.3% (95% CI, 24.2-52.5; I2 =97%).

Further analysis showed that the prevalence of chronic pain among HIV-positive women was similar between those in high-income countries (34.5%) vs those in low- and middle-income countries (28.9%). However, heterogeneity was significant in both the high-income (I2 =96%) and low- and middle-income (I2 =99%) subgroups.

Data captured from 3 studies indicated a higher prevalence of peripheral neuropathy among middle-aged women with HIV infection compared with HIV-negative control participants (20.6% vs 14.0%, respectively; P =.0003).

Limitations of this analysis include significant heterogeneity among the included studies. The researchers also did not conduct important subgroup analyses, such as stratifying study populations by history of AIDS or opportunistic infections, duration of HIV or ART, or exposure to newer vs older ART regimens. In addition, most studies included in the analysis were of moderate quality.

According to the researchers, “[W]e identified that at least one-third of women living with HIV experience chronic pain, underscoring its pervasiveness and signaling the importance of regularly assessing for pain.”


Povshedna T, Swann SA, Levy SLA, et al. Global prevalence of chronic pain in women living with HIV: a systematic review and meta-analysisOpen Forum Infect Dis. Published online July 15, 2023.

This article originally appeared on Infectious Disease Advisor