Pain, mood, and substance abuse in HIV: implications for clinic visit utilization, antiretroviral therapy adherence, and virologic failure.
Pain, mood, and substance abuse in HIV: implications for clinic visit utilization, antiretroviral therapy adherence, and virologic failure.
复制标题
DOI：
10.1097/qai.0b013e3182662215
复制
发表时间：
2012-10-01
期刊：
影响因子：
--
通讯作者：
Mugavero MJ
中科院分区：
文献类型：
--
作者：
Merlin JS;Westfall AO;Raper JL;Zinski A;Norton WE;Willig JH;Gross R;Ritchie CS;Saag MS;Mugavero MJ
同时发生的疼痛、情绪障碍和药物滥用在艾滋病毒感染者中很常见。我们的目的是调查疼痛之间的关系，单独和情绪障碍和药物滥用的背景下，临床利用，抗逆转录病毒治疗（ART）的依从性，和病毒学抑制。疼痛、情绪障碍和药物滥用在第一次就诊时进行评估。在一年的时间内测量了未出现和紧急访问。模型根据年龄、种族、性别、保险状况、CD 4 + T淋巴细胞计数和HIV风险因素进行调整。在1521名参与者中，509名（34%）报告疼痛，239名（16%）仅疼痛，189名（13%）疼痛和情绪障碍，30名（2%）疼痛和药物滥用。在单变量模型中，患有疼痛、情绪障碍和药物滥用的受试者的未就诊几率高于无这些疾病的受试者[OR 1.4（95% CI 1.1-1.8）; OR 1.5（95% CI 1.2-1.9）; OR 2.0（95% CI 1.4-2.8）]。在多变量模型中，疼痛仅在无药物滥用的受试者中增加了未就诊的几率[OR 1.5（95% CI 1.1-1.9）]，疼痛降低了药物滥用受试者中未就诊的几率[OR 0.5（95% CI 0.2-0.9），相互作用p =0.0022]。在这项研究中，疼痛增加了不出现访问的几率，但仅适用于没有药物滥用的参与者。由于疼痛、情绪障碍和药物滥用在艾滋病毒感染者中非常普遍，我们的研究结果对艾滋病毒治疗的成功具有重要意义。包括疼痛管理在内的干预措施可能对改善艾滋病毒感染患者的健康状况很重要。
Co-occurring pain, mood disorders, and substance abuse are common in HIV-infected patients. Our objective was to investigate the relationship between pain, alone and in the context of mood disorders and substance abuse, on clinic utilization, antiretroviral therapy (ART) adherence, and virologic suppression. Pain, mood disorders, and substance abuse were assessed at the first visit. No-show and urgent visits were measured over a one-year period. Models were adjusted for age, race, sex, insurance status, CD4+ T-lymphocyte count, and HIV risk factor. Among 1521 participants, 509 (34%) reported pain, 239 (16%) had pain alone, 189 (13%) had pain and a mood disorder, and 30 (2%) had pain and substance abuse. In univariate models, participants with pain, mood disorders, and substance abuse had higher odds of a no-show visit than participants without these conditions [OR 1.4 (95% CI 1.1–1.8); OR 1.5 (95% CI 1.2–1.9); OR 2.0 (95% CI 1.4–2.8), respectively]. In the multivariable model, pain increased the odds of a no-show visit only in participants without substance abuse [OR 1.5 (95% CI 1.1–1.9)], and pain reduced the odds of a no-show visit in participants with substance abuse [OR 0.5 (95% CI 0.2–0.9), p for interaction=0.0022]. In this study, pain increased the odds of no-show visits, but only for participants without substance abuse. Because pain, mood disorders, and substance abuse are highly prevalent in HIV-infected patients, our findings have implications for HIV treatment success. Interventions that incorporate pain management may be important for improving health outcomes in patients living with HIV infection.