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The association of pain and long-term opioid therapy with HIV treatment outcomes - Chronic Pain Tied to Virologic Failure, While Long-Term Opioids Lower Odds of Failure
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25th Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2018, Boston
Mark Mascolini
Chronic pain doubled the risk of virologic failure in an analysis of 2334 people with HIV in the United States [1]. Long-term opioid therapy (LTOT) nearly halved the risk of virologic failure.
While chronic pain remains prevalent in people with HIV, research has not closely examined the impact of prescribed opioids on retention in care and virologic response. To address those issues, researchers working with the US CNICS cohort conducted this study, aiming specifically to assess potential impacts of LTOT.
All participants were at least 18 years old and in CNICS for at least 1 year. Researchers defined chronic pain as at least moderate pain for 3 or more months on the Brief Chronic Pain Questionnaire; they defined LTOT as an opioid prescription for at least 90 consecutive days. Suboptimal retention meant one no-show to a scheduled visit without another completed visit in a month. Virologic failure meant a viral load above 1000 copies. The CNICS team used multivariable logistic regression to assess the impact of pairwise comparisons between chronic pain and LTOT on suboptimal retention and virologic failure.
The analysis included 2334 people with HIV, 82% of them from the University of Alabama at Birmingham or the University of California, San Diego. While 44% of participants were 50 or older, 16% were women, 48% white, 38% black, and 11% Hispanic. Median CD4 count stood at 590. One quarter of participants had chronic pain, 27% had suboptimal retention, and 15% used LTOT. Only 10% of participants reported substance use in the past 3 months.
Regression analysis determined that pain and LTOT strongly affected suboptimal retention and virologic failure in four ways, as indicated by the following adjusted odds ratios (aOR) and 95% confidence intervals (CI):
Suboptimal retention:
-- Pain and LTOT (vs no pain and no LTOT) marginally raised odds of suboptimal retention: aOR 1.36, 95% CI 0.97 to 1.92, P = 0.07
-- Pain and no LTOT (vs no pain and no LTOT) independently raised odds of suboptimal retention: aOR 1.46, 95% CI 1.1 to 1.93, P = 0.009
Virologic failure:
-- Pain and no LTOT (vs no pain and no LTOT) independently doubled odds of virologic failure: aOR 1.97, 95% CI 1.39 to 2.8, P < 0.001
-- Pain and LTOT (vs pain and no LTOT) independently lowered odds of virologic failure: aOR 0.56, 95% CI 0.33 to 0.96, P = 0.03
The researchers concluded that their analysis linked chronic pain to virologic failure in people not on LTOT. But LTOT did not affect retention in people with chronic pain, a result contrary to findings suggesting that HIV providers occasionally prescribe opioids to encourage retention. Finally, the investigators stressed that LTOT lowered odds of virologic failure in this study group. The CNICS team noted that this analysis involved people with virologic suppression, so results may not apply to other HIV populations.
Reference
1. Merlin J, Long DM, Becker W, et al. The association of pain and long-term opioid therapy with HIV treatment outcomes. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 756.
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