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. 2018 Sep 1;79(1):77-82.
doi: 10.1097/QAI.0000000000001741.

Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes

Jessica S Merlin  1 , Dustin Long  2 , William C Becker, Edward R Cachay  3 , Katerina A Christopoulos  4 , Kasey Claborn  5 , Heidi M Crane  6 , E Jennifer Edelman  7 , Richard Harding  8 , Stefan G Kertesz  9 , Jane M Liebschutz  1 , W Christopher Mathews  3 , Michael J Mugavero  10 , Sonia Napravnik  11 , Connall C OʼCleirigh, Michael S Saag  10 , Joanna L Starrels  12 , Robert Gross  13
Affiliations

Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes

Jessica S Merlin et al. J Acquir Immune Defic Syndr. .

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.

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Conflict of interest statement

Conflicts of Interest: The authors report the following conflicts of interest: Dr. Kertesz reports ownership of stock in Merck and Abbott amount ot less than 3% of assets but no income, honoraria, grants, or other associations with any drug company. Dr. Crane has served on an advisory board for VIIV. Dr. Gross is a member of a Data and Safety Monitoring Board for a Pfizer drug unrelated to HIV or pain treatment. Dr. Starrels receives research support from the Opioid Post-marketing Requirement Consortium to conduct FDA-mandated observational research.

References

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    1. Merlin JS, Cen L, Praestgaard A, Turner M, Obando A, Alpert C, et al. Pain and physical and psychological symptoms in ambulatory HIV patients in the current treatment era. J Pain Symptom Manage. 2012;43(3):638–45. - PMC - PubMed
    1. Merlin J, Selwyn P, Treisman G, Giovaniello A, editors. Chronic pain and HIV: a practical approach. 1. London: Wiley; 2016. in press.
    1. Davis L, Evans S, Fishman B, Haley A, Spielman LA. Predictors of attrition in HIV-positive subjects with peripheral neuropathic pain. AIDS Care. 2004;16(3):395–402. - PubMed

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