Postoperative Pain After Endodontic Treatment in HIV ‐Positive Patients Under HAART : A Prospective Observational Cohort Study

AIM: To compare post-operative pain following root canal treatment (RCT) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) and HIV-negative patients and to assess the influence of systemic condition on endodontic pain. METHODOLOGY: This investigation was designed as a prospective observational cohort study, following the PROBE 2023 guidance. A total of 60 patients (30 HIV-positive under HAART for at least three years with undetectable viral load, and 30 HIV-negative) with pulp necrosis and asymptomatic apical periodontitis were included. All teeth were treated in a single visit by an endodontic specialist using standardised chemo-mechanical preparation with reciprocating instruments, irrigation with 2.5% sodium hypochlorite and 17% EDTA, and single-cone obturation with AH Plus sealer. Patients without preoperative pain (VAS = 0) were included. Post-operative pain was assessed using a VAS, 0-10 at 6, 12, 24, 48 and 72 h and 7 days post-treatment. Statistical analysis was performed using the chi-square test, Kolmogorov-Smirnov test, and Mann-Whitney U test (95% confidence level). RESULTS: No significant differences were found between groups regarding sex, age or tooth location (p > 0.05). Both groups reported postoperative pain in the first 24 h, with no significant differences (p > 0.05). At 48 h, however, all HIV-positive patients reported complete pain relief, whereas the HIV-negative group still presented residual pain, showing a statistically significant difference (p = 0.021). At 72 h and 7 days, both groups reported no pain (VAS = 0). Overall, postoperative pain prevalence exceeded 45% in the first 24 h, regardless of systemic condition. CONCLUSIONS: Postoperative pain patterns were similar in HIV-positive patients under HAART and HIV-negative individuals, except for earlier pain resolution in the HIV-positive group at 48 h. These findings suggest that the systemic condition does not negatively affect the short-term management of endodontic pain.