Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV
Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV
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DOI：
10.1001/jamainternmed.2018.6101
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发表时间：
2019-03-01
影响因子：
39
通讯作者：
Fiellin, David A.
中科院分区：
文献类型：
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作者：
Edelman, E. Jennifer;Gordon, Kirsha S.;Fiellin, David A.
重要性一些阿片类药物是已知的免疫抑制剂；然而，处方阿片类药物与临床相关免疫相关结果的相关性研究不足，特别是在艾滋病毒携带者中。目的通过阿片类药物的性质和艾滋病毒状况来评估处方阿片类药物与社区获得性肺炎(CAP)的相关性。设计、背景和参与者这项嵌套的病例对照研究使用了2000年1月1日至2012年12月31日退伍军人老龄化队列研究(Vacs)患者的数据。Vacs的参与者包括在美国各地的退伍军人健康管理局(VA)医疗中心接受护理的艾滋病毒携带者和非HIV携带者。需要住院的CAP患者(n=4246)与非CAP的对照组(n=21146)按年龄、性别、种族/民族、观察时间和HIV状况进行1：5匹配。分析了2017年3月15日至2018年8月8日的数据。指数日期前12个月期间处方阿片类药物暴露的特征是基于时间(无、过去或当前)；低(<；20 mg)、中(20-50 mg)或高(>；50 mg)吗啡等效日剂量中位数；以及阿片类免疫抑制特性(是与未知或否)的复合变量。平均[SD]年龄，55[10]岁；当前中剂量免疫抑制属性(调整后的优势比[AOR]，1.35；95%CI，1.13-1.62)和免疫抑制属性(AOR，2.07；95%CI，1.50-2.86)；当前大剂量免疫抑制属性(AOR，2.07；95%CI，1.50-2.86)和免疫抑制属性(AOR，3.18；与没有处方阿片类药物或任何过去没有免疫抑制的处方阿片类药物(AOR，1.24；95%CI，1.09-1.40)和免疫抑制特性(AOR，1.42；95%CI，1.21-1.67)相比，CAP的风险最大。在分层分析中，在使用当前处方阿片类药物的艾滋病毒携带者中，CAP风险始终较高，尤其是当开出免疫抑制类阿片类药物时(例如，当前免疫抑制类阿片类药物中剂量的AORS，1.76[95%CI，1.20-2.57]vs 2.33[95%CI，1.60-3.40])。结论与处方阿片类药物相关，尤其是大剂量和免疫抑制类阿片类药物，与HIV携带者和非HIV携带者CAP风险增加有关。
IMPORTANCE Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV.OBJECTIVE To assess the association of prescribed opioids with community-acquired pneumonia (CAP) by opioid properties and HIV status.DESIGN, SETTING, AND PARTICIPANTS This nested case-control study used data from patients in the Veterans Aging Cohort Study (VACS) from January 1, 2000, through December 31, 2012. Participants in VACS included patients living with and without HIV who received care in Veterans Health Administration (VA) medical centers across the United States. Patients with CAP requiring hospitalization (n = 4246) were matched 1:5 with control individuals without CAP (n = 21 146) by age, sex, race/ethnicity, length of observation, and HIV status. Data were analyzed from March 15, 2017, through August 8, 2018.EXPOSURES Prescribed opioid exposure during the 12 months before the index date was characterized by a composite variable based on timing (none, past, or current); low (< 20 mg), medium (20-50 mg), or high (> 50 mg) median morphine equivalent daily dose; and opioid immunosuppressive properties (yes vs unknown or no).MAIN OUTCOME AND MEASURE CAP requiring hospitalization based on VA and Centers for Medicare & Medicaid data.RESULTS Among the 25 392 VACS participants (98.9% male; mean [SD] age, 55 [10] years), current medium doses of opioids with unknown or no immunosuppressive properties (adjusted odds ratio [AOR], 1.35; 95% CI, 1.13-1.62) and immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and current high doses of opioids with unknown or no immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and immunosuppressive properties (AOR, 3.18; 95% CI, 2.44-4.14) were associated with the greatest CAP risk compared with no prescribed opioids or any past prescribed opioid with no immunosuppressive (AOR, 1.24; 95% CI, 1.09-1.40) and immunosuppressive properties (AOR, 1.42; 95% CI, 1.21-1.67), especially with current receipt of immunosuppressive opioids. In stratified analyses, CAP risk was consistently greater among people living with HIV with current prescribed opioids, especially when prescribed immunosuppressive opioids (eg, AORs for current immunosuppressive opioids with medium dose, 1.76 [95% CI, 1.20-2.57] vs 2.33 [95% CI, 1.60-3.40]).CONCLUSIONS AND RELEVANCE Prescribed opioids, especially higher-dose and immunosuppressive opioids, are associated with increased CAP risk among persons with and without HIV.