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.
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.
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).
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.
*Divisions of General Internal Medicine and Infectious Diseases, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA;
†Department of Biostatics, University of Alabama at Birmingham School of Public Health, Birmingham, AL;
‡Department of Medicine, Section of General Internal Medicine, Yale School of Medicine, VA Connecticut Healthcare System, New Haven, CT;
§Division of Infectious Diseases, Department of Medicine, Owen Clinic, University of California, San Diego, San Diego, CA;
║Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA;
¶Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX;
#Division of Infectious Disease, Department of Medicine, University of Washington, Seattle, WA;
**Yale University Schools of Medicine and Public Health, New Haven, CT;
††Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom;
‡‡Birmingham Veterans Affairs Medical Center, University of Alabama at Birmingham School of Medicine, Birmingham, AL;
§§Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;
║║Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;
¶¶Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, The Fenway Institute, Boston, MA;
##Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; and
***Departments of Medicine (ID) and Epidemiology/Biostatistics/Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Correspondence to: Jessica S. Merlin, MD, PhD, MBA, University of Pittsburgh School of Medicine, Division of General Internal Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 (e-mail: firstname.lastname@example.org).
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].
S.G.K. reports ownership of stock in Merck and Abbott amount of less than 3% of assets but no income, honoraria, grants, or other associations with any drug company. H.M.C. has served on an advisory board for VIIV. R.G. is a member of a Data and Safety Monitoring Board for a Pfizer drug unrelated to HIV or pain treatment. J.L.S. receives research support from the Opioid Post-marketing Requirement Consortium to conduct FDA-mandated observational research. The remaining authors have no funding or conflicts of interest to disclose.
Received December 20, 2017
Accepted April 06, 2018