Brief report

The association of chronic pain and long-term opioid therapy with HIV treatment outcomes

Jessica S. Merlin, Dustin Long, William C. Becker, Edward R. Cachay, Katerina A. Christopoulos, Kasey Claborn, Heidi M. Crane, E. Jennifer Edelman, Richard Harding, Stefan G. Kertesz, Jane M. Liebschutz, W. Christopher Mathews, Michael J. Mugavero, Sonia Napravnik, Connall C. O'Cleirigh, Michael S. Saag, Joanna L. Starrels, Robert Gross

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Chronic pain occurs in up to 85% of persons living with HIV and is commonly treated with long-term opioid therapy (LTOT). We investigated the impact of chronic pain and LTOT on HIV outcomes. Methods: This was prospective cohort study conducted between July 2015 and July 2016 in 5 HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire. Chronic pain and LTOT were assessed at an index visit. Suboptimal retention, defined as at least one "no-show" to primary care, and virologic failure were measured over the subsequent year. Multivariable logistic regression models were built for each outcome adjusting for site. Results: Among 2334 participants, 25% had chronic pain, 27% had suboptimal retention, 12% had virologic failure, and 19% were prescribed LTOT. Among individuals not on LTOT, chronic pain was associated with increased odds of suboptimal retention [adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI): 1.10 to 1.93, P = 0.009] and virologic failure (aOR 1.97, 95% CI: 1.39 to 2.80, P < 0.001). Among individuals with chronic pain, there was no association between LTOT and retention, but LTOT was associated with lower rates of virologic failure (aOR 0.56, 95% CI: 0.33 to 0.96, P = 0.03). Conclusions: Chronic pain in participants not on LTOT was associated with virologic failure. This reinforces the need to identify effective chronic pain treatments for persons living with HIV and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration.

Original languageEnglish (US)
Pages (from-to)77-82
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume79
Issue number1
DOIs
StatePublished - Sep 1 2018

Fingerprint

Chronic Pain
Opioid Analgesics
HIV
Therapeutics
Odds Ratio
Confidence Intervals
Primary Health Care
Logistic Models
Pain
Cohort Studies
Prospective Studies

Keywords

  • chronic pain
  • HIV
  • opioids
  • retention in care
  • virologic failure

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Merlin, J. S., Long, D., Becker, W. C., Cachay, E. R., Christopoulos, K. A., Claborn, K., ... Gross, R. (2018). Brief report: The association of chronic pain and long-term opioid therapy with HIV treatment outcomes. Journal of Acquired Immune Deficiency Syndromes, 79(1), 77-82. https://doi.org/10.1097/QAI.0000000000001741

Brief report : The association of chronic pain and long-term opioid therapy with HIV treatment outcomes. / Merlin, Jessica S.; Long, Dustin; Becker, William C.; Cachay, Edward R.; Christopoulos, Katerina A.; Claborn, Kasey; Crane, Heidi M.; Edelman, E. Jennifer; Harding, Richard; Kertesz, Stefan G.; Liebschutz, Jane M.; Mathews, W. Christopher; Mugavero, Michael J.; Napravnik, Sonia; O'Cleirigh, Connall C.; Saag, Michael S.; Starrels, Joanna L.; Gross, Robert.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 79, No. 1, 01.09.2018, p. 77-82.

Research output: Contribution to journalArticle

Merlin, JS, Long, D, Becker, WC, Cachay, ER, Christopoulos, KA, Claborn, K, Crane, HM, Edelman, EJ, Harding, R, Kertesz, SG, Liebschutz, JM, Mathews, WC, Mugavero, MJ, Napravnik, S, O'Cleirigh, CC, Saag, MS, Starrels, JL & Gross, R 2018, 'Brief report: The association of chronic pain and long-term opioid therapy with HIV treatment outcomes', Journal of Acquired Immune Deficiency Syndromes, vol. 79, no. 1, pp. 77-82. https://doi.org/10.1097/QAI.0000000000001741
Merlin, Jessica S. ; Long, Dustin ; Becker, William C. ; Cachay, Edward R. ; Christopoulos, Katerina A. ; Claborn, Kasey ; Crane, Heidi M. ; Edelman, E. Jennifer ; Harding, Richard ; Kertesz, Stefan G. ; Liebschutz, Jane M. ; Mathews, W. Christopher ; Mugavero, Michael J. ; Napravnik, Sonia ; O'Cleirigh, Connall C. ; Saag, Michael S. ; Starrels, Joanna L. ; Gross, Robert. / Brief report : The association of chronic pain and long-term opioid therapy with HIV treatment outcomes. In: Journal of Acquired Immune Deficiency Syndromes. 2018 ; Vol. 79, No. 1. pp. 77-82.
@article{e4498d88e87e470f82970147a32b6f9d,
title = "Brief report: The association of chronic pain and long-term opioid therapy with HIV treatment outcomes",
abstract = "Background: Chronic pain occurs in up to 85{\%} of persons living with HIV and is commonly treated with long-term opioid therapy (LTOT). We investigated the impact of chronic pain and LTOT on HIV outcomes. Methods: This was prospective cohort study conducted between July 2015 and July 2016 in 5 HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire. Chronic pain and LTOT were assessed at an index visit. Suboptimal retention, defined as at least one {"}no-show{"} to primary care, and virologic failure were measured over the subsequent year. Multivariable logistic regression models were built for each outcome adjusting for site. Results: Among 2334 participants, 25{\%} had chronic pain, 27{\%} had suboptimal retention, 12{\%} had virologic failure, and 19{\%} were prescribed LTOT. Among individuals not on LTOT, chronic pain was associated with increased odds of suboptimal retention [adjusted odds ratio (aOR) 1.46, 95{\%} confidence interval (CI): 1.10 to 1.93, P = 0.009] and virologic failure (aOR 1.97, 95{\%} CI: 1.39 to 2.80, P < 0.001). Among individuals with chronic pain, there was no association between LTOT and retention, but LTOT was associated with lower rates of virologic failure (aOR 0.56, 95{\%} CI: 0.33 to 0.96, P = 0.03). Conclusions: Chronic pain in participants not on LTOT was associated with virologic failure. This reinforces the need to identify effective chronic pain treatments for persons living with HIV and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration.",
keywords = "chronic pain, HIV, opioids, retention in care, virologic failure",
author = "Merlin, {Jessica S.} and Dustin Long and Becker, {William C.} and Cachay, {Edward R.} and Christopoulos, {Katerina A.} and Kasey Claborn and Crane, {Heidi M.} and Edelman, {E. Jennifer} and Richard Harding and Kertesz, {Stefan G.} and Liebschutz, {Jane M.} and Mathews, {W. Christopher} and Mugavero, {Michael J.} and Sonia Napravnik and O'Cleirigh, {Connall C.} and Saag, {Michael S.} and Starrels, {Joanna L.} and Robert Gross",
year = "2018",
month = "9",
day = "1",
doi = "10.1097/QAI.0000000000001741",
language = "English (US)",
volume = "79",
pages = "77--82",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Brief report

T2 - The association of chronic pain and long-term opioid therapy with HIV treatment outcomes

AU - Merlin, Jessica S.

AU - Long, Dustin

AU - Becker, William C.

AU - Cachay, Edward R.

AU - Christopoulos, Katerina A.

AU - Claborn, Kasey

AU - Crane, Heidi M.

AU - Edelman, E. Jennifer

AU - Harding, Richard

AU - Kertesz, Stefan G.

AU - Liebschutz, Jane M.

AU - Mathews, W. Christopher

AU - Mugavero, Michael J.

AU - Napravnik, Sonia

AU - O'Cleirigh, Connall C.

AU - Saag, Michael S.

AU - Starrels, Joanna L.

AU - Gross, Robert

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Chronic pain occurs in up to 85% of persons living with HIV and is commonly treated with long-term opioid therapy (LTOT). We investigated the impact of chronic pain and LTOT on HIV outcomes. Methods: This was prospective cohort study conducted between July 2015 and July 2016 in 5 HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire. Chronic pain and LTOT were assessed at an index visit. Suboptimal retention, defined as at least one "no-show" to primary care, and virologic failure were measured over the subsequent year. Multivariable logistic regression models were built for each outcome adjusting for site. Results: Among 2334 participants, 25% had chronic pain, 27% had suboptimal retention, 12% had virologic failure, and 19% were prescribed LTOT. Among individuals not on LTOT, chronic pain was associated with increased odds of suboptimal retention [adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI): 1.10 to 1.93, P = 0.009] and virologic failure (aOR 1.97, 95% CI: 1.39 to 2.80, P < 0.001). Among individuals with chronic pain, there was no association between LTOT and retention, but LTOT was associated with lower rates of virologic failure (aOR 0.56, 95% CI: 0.33 to 0.96, P = 0.03). Conclusions: Chronic pain in participants not on LTOT was associated with virologic failure. This reinforces the need to identify effective chronic pain treatments for persons living with HIV and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration.

AB - Background: Chronic pain occurs in up to 85% of persons living with HIV and is commonly treated with long-term opioid therapy (LTOT). We investigated the impact of chronic pain and LTOT on HIV outcomes. Methods: This was prospective cohort study conducted between July 2015 and July 2016 in 5 HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire. Chronic pain and LTOT were assessed at an index visit. Suboptimal retention, defined as at least one "no-show" to primary care, and virologic failure were measured over the subsequent year. Multivariable logistic regression models were built for each outcome adjusting for site. Results: Among 2334 participants, 25% had chronic pain, 27% had suboptimal retention, 12% had virologic failure, and 19% were prescribed LTOT. Among individuals not on LTOT, chronic pain was associated with increased odds of suboptimal retention [adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI): 1.10 to 1.93, P = 0.009] and virologic failure (aOR 1.97, 95% CI: 1.39 to 2.80, P < 0.001). Among individuals with chronic pain, there was no association between LTOT and retention, but LTOT was associated with lower rates of virologic failure (aOR 0.56, 95% CI: 0.33 to 0.96, P = 0.03). Conclusions: Chronic pain in participants not on LTOT was associated with virologic failure. This reinforces the need to identify effective chronic pain treatments for persons living with HIV and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration.

KW - chronic pain

KW - HIV

KW - opioids

KW - retention in care

KW - virologic failure

UR - http://www.scopus.com/inward/record.url?scp=85056296446&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056296446&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000001741

DO - 10.1097/QAI.0000000000001741

M3 - Article

VL - 79

SP - 77

EP - 82

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 1

ER -