Pain and substance use among persons living with HIV: associations with co-morbid illness and viral suppression

Background: Pain is common in persons with HIV, who often report mental health symptoms and substance use, all of which may affect viral suppression. Objective: To investigate correlates of self-reported pain and associations with viral suppression among people with HIV. Methods: We analysed data from 3422 self-interviews contributed by 1626 unique patients in continuity care in the Johns Hopkins HIV Clinical Cohort between October 2013 and December 2018. Self-reported pain was measured using the EuroQol-5D-3L (“Have you had any pain or discomfort today?”). The correlations included PTSD, anxiety, depressive symptoms, and substance use. Viral suppression (HIV RNA ≤ 200 copies/mL) is routinely collected for clinical care and was abstracted between 9 months prior to 1 week after the self-interview. Results: Pain was more prevalent in patients who were older, female, white, and who reported mental health symptoms or who had a recent or past prescription for an opioid. The prevalence ratio between pain and viral non-suppression was consistent with no association and also a weak positive association (1.07, 95% CI: 0.95, 1.21). Conclusions: Tailored interventions for mental health may improve pain and HIV outcomes.