Non-Medical Use of Prescription Opioids Among HIV-Infected Individuals: Trajectories and Impact on Health Outcomes

项目摘要/摘要 在处方使用量空前上升的背景下，艾滋病毒感染者(HIV+)的寿命变长了 阿片类药物用于治疗疼痛和同时流行的NMUPO。HIV+个体的比例不成比例 受疼痛、抑郁、创伤后应激障碍和药物使用的影响，增加了他们患非 处方类阿片的医疗用途(NMUPO：在没有处方的情况下使用处方类阿片或仅用于 体验或感觉到毒品造成的)及其相关的危害。这在HIV+患者中尤其如此 他们也是老兵。现有的关于HIV+个体中NMUPO的文献在绘制时是有限的 来自不可推广的人群；是在早期艾滋病毒治疗时代收集的；并依赖于横断面 设计或限制长期随访。此外，关于可修改因素(即处方)的作用的数据 阿片类药物和苯二氮类药物)对NMUPO的影响及其后果是稀少的。了解NMUPO模式 随着时间的推移，导致NMUPO上升的因素及其对健康结果的相关影响对于 设计干预措施改善艾滋病毒阳性退伍军人的健康结果。因此，我们的目标是利用现有的 退伍军人老龄化队列研究(VVS)中2800名HIV+患者的纵向数据特征：1) NMUPO的重要轨迹，如使用升级，2)NMUPO轨迹之间的关联 和艾滋病毒相关的结果，以及3)NMUPO轨迹和死亡率之间的关联。Vacs数据将 请允许我们在通过九个退伍军人事务部接受护理的HIV+患者队列中检查这些目标 美国各地的传染病诊所。自2005年以来，Vacs已经收集了三次调查浪潮 自我报告的措施包括NMUPO使用国家药物使用与健康，疼痛， 抑郁症状，以及其他物质的使用。这些自我报告数据将由详细的 通过电子病历提供的信息，包括处方(如阿片类药物和 医疗和精神诊断(如创伤后应激障碍)和实验室数据。与艾滋病毒相关的结果 包括Vacs指数评分，这是一种从常规实验室派生的经过验证的复合生物标记物，是 总体艾滋病毒疾病严重程度，并准确预测死亡率；可检测到的病毒载量和艾滋病毒护理中的滞留。 这项研究的创新之处包括侧重于从事常规医疗护理的患者 在退伍军人事务部(即美国最大的艾滋病毒单一提供者)中，评估NMUPO和 同时提供详细的处方阿片类药物信息(包括持续时间、剂量、配方)和 苯二氮卓类药物，以及结合双结果轨迹模型的纵向分析方法 评估NMUPO轨迹及其对重要健康结果的影响，包括Vacs指数和 死亡率。这项工作由一个在观察和干预方面拥有专业知识的多学科团队进行 研究，将提供必要的数据，为未来筛查和治疗策略的发展提供信息 在HIV+患者中降低NMUPO和处方药的风险并防止危害。

Project Summary/Abstract HIV-infected (HIV+) patients are living longer in the context of an unprecedented rise in the use of prescription opioids for the treatment of pain and a concurrent epidemic of NMUPO. HIV+ individuals are disproportionately impacted by pain, depression, post-traumatic stress disorder and substance use, increasing their risk for non- medical use of prescription opioids (NMUPO: use of prescription opioids without a prescription or simply for the experience or feeling the drugs cause) and its associated harms. This is especially true among HIV+ patients who are also veterans. Existing literature regarding NMUPO among HIV+ individuals is limited as it is drawn from non-generalizable populations; was collected in earlier HIV treatment eras; and relies on cross-sectional designs or limited long-term follow-up. Further, data regarding the role of modifiable factors (i.e. prescription opioids and benzodiazepines) on NMUPO and its consequences are sparse. Understanding NMUPO patterns over time, factors contributing to escalating NMUPO, and its associated impact on health outcomes is critical to designing interventions improve health outcomes in HIV+ veterans. Therefore, our aims are to use existing longitudinal data on >2800 HIV+ individuals in the Veterans Aging Cohort Study (VACS) to characterize: 1) important trajectories of NMUPO such as escalation of use, 2) the association between NMUPO trajectories and HIV-related outcomes, and 3) the association between NMUPO trajectories and mortality. VACS data will allow us to examine these aims among a cohort of HIV+ patients receiving care through nine Veterans Affairs Infectious Disease clinics across the United States. Since 2005, VACS has collected three survey waves of self-reported measures including NMUPO using items from the National Survey on Drug Use and Health, pain, depressive symptoms, and other substance use. These self-report data will be supplemented by detailed information available through the electronic medical record, including prescriptions (e.g. opioids and benzodiazepines), medical and psychiatric diagnoses (i.e. PTSD), and laboratory data. HIV-related outcomes include VACS Index score, a validated composite biomarker derived from routine labs that is a measure of overall HIV disease severity and accurately predicts mortality; detectable viral load and retention in HIV care. The innovative aspects of this research include its focus on patients who are engaged in routine medical care in the VA (i.e. the largest single provider of HIV in the United States), the ability to evaluate NMUPO and simultaneous detailed prescription opioid information (including duration, dose, formulation) and benzodiazepines, and a longitudinal analytic approach that incorporates dual-outcome trajectory models to evaluate NMUPO trajectories and their impact on important health outcomes, including the VACS Index and mortality. This work, conducted by a multidisciplinary team with expertise in observational and intervention research, will provide essential data to inform the development of future screening and treatment strategies to mitigate risks and prevent harm of NMUPO and prescribed medications among HIV+ patients.