RESUMO
Objective: The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to quantify the association between fall risk and various categories of drugs used in ART. Material and Methods: PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Any observational study or controlled trial that reported on the relationship of at least one antiretroviral drug with falls in PLHIVs was included. Data on the frequency of single fallers, multiple fallers (≥2 falls), and non-fallers were extracted and studied for each drug and drug category. The pooled results were reported as an odds ratio (OR) with a 95% confidence interval (CI). Results: A total of five observational studies (51 675 participants) were included out of 414 articles obtained through a literature review. Stavudine use was found to be associated with an increased risk of single falls in PLHIVs (OR: 1.69, 95% CI: 1.08-2.66, P=0.02). However, efavirenz (OR: 0.82, 95% CI=0.76-0.89, P<0.001) and zidovudine (OR: 0.82, 95% CI=0.77-0.92, P<0.001) were found protective against the single falls. Didanosine had no significant association with fall risk (OR: 1.23, 95% CI: 0.78-1.93, P=0.37). Likewise, protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were discovered to have no significant association with fall risk. Conclusion: Most drug categories of ART have no significant association with the risk of falls in PLHIVs. However, certain drugs, such as didanosine and stavudine, which have the inherent effect of causing balance deficits and neuropathy, should be used cautiously.
RESUMO
Chronic pain is a debilitating condition that affects many individuals throughout their daily lives. While it is common to treat chronic pain with pharmaceutical treatments, an approach that has also shown great benefits is the use of integrative medicine, such as massage therapy, osteopathic and spinal manipulation, acupuncture, and yoga. The keywords "integrative medicine," "pain," "chronic pain," and "pain management" with the use of the Boolean operators "AND," "OR," and "NOT" were used to identify relevant studies discussing the effectiveness of alternative medicine in the treatment of chronic pain. Massage therapy uses different forms of pressing, rubbing, and moving of muscles and other soft tissues, and has shown short-term benefits for chronic pain relief. Osteopathic and spinal manipulation is mainly used in treating muscles, tendons, and bone pain due to worn-out joints, torn ligaments, and more. Acupuncture involves penetrating the skin with thin needles which are activated through gentle and specific movements. According to our review, acupuncture and massage therapy are effective for short-term treatment, lasting three to five months for chronic pain. Yoga involves various physical, mental, and spiritual practices or disciplines that have shown beneficial results in the treatment of chronic pain. Combining yoga with physical therapy has shown significant benefits. This review aims to describe the benefits and uses of integrative medicine in the treatment of chronic pain.