Causes Of Pain In

Pain may be caused by:1

• damage by HIV itself, for example HIV enteritis, HIV distal sensory polyneuropathy;

• disease arising because of immunosuppression, for example cerebral lymphoma causing headache, acute zoster pain;

• consequent on HIV treatment or drugs used for concomitant illness, for example antiretroviral toxic neuropathy;

• immune reconstitution inflammatory syndrome (IRIS). A result of restoration of immune function and unmasking of the symptoms from previous illness, for example herpes simplex and zoster infections;

• causes unrelated to HIV.

Knowledge of the degree of immunosuppression is vital when diagnosing pain in an HIV-infected individual. Monitoring CD4 count and viral load, the "surrogate markers'' of progression of HIV, can help predict whether infective or neoplastic complications are likely. The antiretroviral drug history is also essential to suggest causes of pain and predict potential drug interactions. HIV therapy should only be changed or interrupted by HIV specialist clinicians because of the limited options for treatment and the propensity for the virus to mutate, resulting in resistance. Drug interactions can be serious as they can result in reduced efficacy of one of the anti-retroviral drugs and subsequent development of resistant virus (see www.tthhivclinic.com).

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