OBJECTIVE: People living with HIV (PLWH) frequently experience pain, which often co-occurs with psychological symptoms and may impact functional outcomes. We investigated cross-sectional associations between pain, depressive symptoms, and inflammation, then explored whether pain was related to poorer physical function among older PLWH.

METHODS: We examined data from PLWH ages 54-78 (n = 162) recruited from a single outpatient program for a larger study on HIV and aging. Participants reported depressive symptoms (CES-D-10), then attended a biomedical visit in which they reported past-month pain (MOS-HIV pain subscale), completed physical function assessments, and provided blood samples (assayed for IL-6, IFN-γ, TNF-α, and CRP). Links between pain, depressive symptoms, inflammation, and physical function were tested using linear regression models.

RESULTS: PLWH with greater depressive symptoms experienced more pain than those with fewer depressive symptoms (B = 1.31, SE = 0.28, p < 0.001), adjusting for age, gender, race, BMI, smoking, disease burden, time since HIV diagnosis, and medication use. Higher composite cytokine levels were associated with worse pain (B = 5.70, SE = 2.54, p = 0.027 in adjusted model). Poorer physical function indicators, including slower gait speed, weaker grip strength, recent falls, and pre-frail or frail status, were observed among those with worse pain. Exploratory mediation analyses suggested that pain may partially explain links between depressive symptoms and several physical function outcomes.

CONCLUSIONS: Pain is a potential pathway linking depressive symptoms and inflammation to age-related health vulnerabilities among older PLWH; longitudinal investigation of this pattern is warranted. PLWH presenting with pain may benefit from multidisciplinary resources, including behavioral health and geriatric medicine approaches.