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Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis

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Anaesthesiology Department, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, 54124 Thessaloniki, Greece
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Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, 54124 Thessaloniki, Greece
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Intensive Care Unit, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, 54124 Thessaloniki, Greece
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Oncology Department, General Hospital of Kavala, 65500 Kavala, Greece
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Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 25510 Alexandroupolis, Greece
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(12), 762; https://doi.org/10.3390/medicina55120762
Received: 8 September 2019 / Revised: 4 November 2019 / Accepted: 19 November 2019 / Published: 28 November 2019
Background and Objectives: Among HIV infection symptoms, sensory neuropathy (HIV-SN) remains a main cause of suffering, with incidence varying from 13–50%. So far, numerous pharmacological and non-pharmacological treatments have been tested, although few evidence-based analgesic options are available. We conducted an up-to-date systematic review and meta-analysis of the literature in order to evaluate the efficacy and safety of pharmacologic and non-pharmacologic treatments for pain control, in patients with HIV neuropathy. Materials and Methods: We searched MEDLINE, EMBASE, Scopus/Elsevier, The Cochrane Central Register of Controlled Trials (CENTRAL), USA Clinical Trials registry, and The International Web of Science up to April 2019. All randomized controlled trials evaluating efficacy and safety of non-pharmacologic and pharmacologic therapies were included. Efficacy was defined as pain reduction during the study period. Safety was estimated from adverse events. A meta-analysis was performed whenever possible. Results: 27 randomized controlled trials (RCTs) were included for analysis (7 evaluating non pharmacologic interventions, 20 pharmacologic therapies). Non-pharmacologic studies (n = 742) involved seven different therapeutic modalities. Only Acupuncture/Moxibustion showed pain reduction over placebo, Gracely Pain Scale Mean (SD): Acu/Moxa 0.85 (0.12), placebo 1.10 (0.09), p = 0.05. Pharmacologic studies, involving 2516 patients revealed efficacy for capsaicin 8% over placebo (mean difference −8.04 [95% CI: −14.92 −1.15], smoked cannabis (where pooling data for meta-analysis was not possible) and recombinant Nerve Growth Factor. Conclusion: Despite various modalities for pain control in HIV-SN, strongest evidence exists for capsaicin 8% and smoked cannabis, although of low methodological quality. Among non-pharmacologic modalities, only Acu/Moxa gave a marginal beneficial effect in one study, possibly limited by inherent methodological flaws. View Full-Text
Keywords: HIV; infectious disease; pain; neuropathy HIV; infectious disease; pain; neuropathy
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Amaniti, A.; Sardeli, C.; Fyntanidou, V.; Papakonstantinou, P.; Dalakakis, I.; Mylonas, A.; Sapalidis, K.; Kosmidis, C.; Katsaounis, A.; Giannakidis, D.; Koulouris, C.; Aidoni, Z.; Michalopoulos, N.; Zarogoulidis, P.; Kesisoglou, I.; Ioannidis, A.; Vagionas, A.; Romanidis, K.; Oikonomou, P.; Grosomanidis, V. Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis. Medicina 2019, 55, 762.

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