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
N1 - Funding Information:
Supported by the National Institutes of Health, including the following grants: K23MH104073 (J.S.M.), R01DA040471 (E.J.E.), R01DA039046 (J.L.S.), the Penn Center for AIDS Research (CFAR) (P30 AI 045008) (R.G.), K23DA039037 (KRC), and the Penn Mental Health AIDS Research Center (PMHARC) (P30 MH 097488) (R.G.). Additional support came from the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health [CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757; UNC CFAR grant P30 AI50410, and UAB CFAR grant P30 AI027767] and the National Institutes of Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health [U24AA020801, U01AA020793, and U01AA020802].
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
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 - HIV
KW - chronic pain
KW - opioids
KW - retention in care
KW - virologic failure
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U2 - 10.1097/QAI.0000000000001741
DO - 10.1097/QAI.0000000000001741
M3 - Article
C2 - 29771793
AN - SCOPUS:85056296446
SN - 1525-4135
VL - 79
SP - 77
EP - 82
JO - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
JF - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
IS - 1
ER -
