Chronic pain common in people living with virus
An effective Human Immuno-deficiency Virus (HIV) vaccine may be a short step away now scientists have overcome a major stumbling block hindering its development.
The big hurdle has been the inability to generate immune cells that stay in circulation long enough to stop the Aids virus spreading. International researchers believe they have solved the problem by ‘unblocking’ a process linked to an HIV protein that was halting the production of antibody-generating ‘B-cells’ from the immune system.
Lead scientist Professor Jonathan Heeney, from Cambridge University, said: “For a vaccine to work, its effects need to be long lasting.“It isn’t practical to require people to come back every six to 12 months to be vaccinated. We wanted to develop a vaccine to overcome this block and generate these long-lived antibody producing cells. We have now found a way to do this.
“What we have found is a way to greatly improve B-cell responses to an HIV vaccine. We hope our discovery will unlock the paralysis in the field of HIV vaccine research and enable us to move forward.”
The researchers compared their achievement, reported in the Journal of Virology, to “preventing a key getting stuck in a lock”.In laboratory experiments, the new approach produced desired immune system responses that lasted more than a year.In future it should be possible to produce vaccines that stimulate long-lasting B-cell responses against HIV, the scientists believe.
Prof Heeney added: “B-cells need time to make highly effective neutralising antibodies, but in previous studies B-cell responses were so short lived they disappeared before they had the time to make all the changes necessary to create the “silver bullets” to stop HIV.
“We hope our discovery will unlock the paralysis in the field of HIV vaccine research and enable us to move forward.” Also, because ongoing pain is a significant problem that affects 39 to 85 percent of people living with Human Immuno-deficiency Virus (HIV), everyone with the infection should be assessed for chronic pain, recommend guidelines released by the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Diseases. Those who screen positive should be offered a variety of options for managing pain, starting with non-drug treatment such as cognitive behavioral therapy, yoga and physical therapy, suggest the first comprehensive guidelines on HIV and chronic pain.
“Because HIV clinicians typically are not experts in pain management, they should work closely with others, such as pain specialists, psychiatrists and physical therapists to help alleviate their patients’ pain,” said Douglas Bruce, MD, MA, MS, lead author of the guidelines, chief of medicine at Cornell Scott-Hill Health Center, and associate clinical professor of medicine at Yale University, New Haven, Conn. “These comprehensive guidelines provide the tools and resources HIV specialists need to treat these often-complex patients, many of whom struggle with depression, substance use disorders, and have other health conditions such as diabetes.”
The guidelines recommend all people with HIV be screened for chronic pain using a few simple questions:
*How much bodily pain have you had during the week?
*Do you have bodily pain that has lasted more than three months?
Those that screen positive should undergo comprehensive evaluation, including a physical exam, psychosocial evaluation and diagnostic testing. Nearly half of chronic pain in people with HIV is neuropathic (nerve pain), likely due to inflammation or injury to the central or peripheral nervous system caused by the infection. Non-neuropathic pain typically is musculoskeletal, such as low-back pain and osteoarthritis in the joints.
HIV specialists should work with an interdisciplinary team to offer multi-modal treatment. The guidelines recommend offering alternative, non-pharmacological therapies first, including cognitive behavioral therapy, yoga, physical and occupational therapy, hypnosis and acupuncture. If medication is needed, the guidelines recommend beginning with non-opioids, such as gabapentin (anti-seizure medicine) and capsaicin (topical pain reliever made from chili peppers), both of which help with nerve pain. The online version of the guidelines includes an extensive list of resources for physicians to reference to help them treat the patients comprehensively.