Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes.
Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes.
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DOI：
10.1097/qai.0000000000001741
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发表时间：
2018-09-01
期刊：
影响因子：
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通讯作者：
Gross R
中科院分区：
文献类型：
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作者：
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;C OʼCleirigh C;Saag MS;Starrels JL;Gross R
高达85%的艾滋病毒感染者（PLWH）出现慢性疼痛，通常通过长期阿片类药物治疗（LTOT）进行治疗。我们调查了慢性疼痛和ltt对HIV预后的影响。这是一项前瞻性队列研究，于2015年7月至2016年7月在五家HIV初级保健诊所进行。慢性疼痛定义为：在简短慢性疼痛问卷中疼痛≥3个月，在疼痛享受生活和一般活动（PEG）问卷中疼痛≥4/10。慢性疼痛和LTOT在索引访问时进行评估。在随后的一年中测量了次优保留率，定义为至少一次“没有出现”到初级保健，以及病毒学失败。为每个结果建立多变量logistic回归模型。在2334名参与者中，25%患有慢性疼痛，27%患有次优潴留，12%患有病毒学失败，19%服用了LTOT。在未接受LTOT治疗的患者中，慢性疼痛与亚理想滞留（aOR 1.46, 95% CI 1.10-1.93, p=0.009）和病毒学失败（aOR 1.97, 95% CI 1.39-2.80, p<0.001）的几率增加相关。在患有慢性疼痛的个体中，LTOT与滞留没有关联，但LTOT与较低的病毒学失败率相关（aOR 0.56, 95% CI 0.33-0.96, p=0.03）。未接受LTOT治疗的慢性疼痛与病毒学失败有关。这加强了确定有效的慢性疼痛治疗的必要性，并调查其对艾滋病毒结局的影响。在疼痛患者中，LTOT与病毒学失败之间的明显保护关联值得进一步探索。
Chronic pain occurs in up to 85% of persons living with HIV (PLWH) 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 7/2015–7/2016 in five HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire and ≥4/10 on the Pain Enjoyment of life and General activity (PEG) 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 (aOR 1.46, 95% CI 1.10–1.93, p=0.009) and virologic failure (aOR 1.97, 95% CI 1.39–2.80, 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 0.33–0.96, 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 PLWH and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration.