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

项目总结/摘要 艾滋病毒感染者（HIV+）的寿命在处方药使用量空前增加的背景下延长 阿片类药物用于治疗疼痛和NMUPO的并发流行。艾滋病毒阳性者不成比例 受疼痛、抑郁、创伤后应激障碍和物质使用的影响，增加了他们患非创伤性疾病的风险。 处方阿片类药物的医疗用途（NMUPO：无处方或仅用于 体验或感受药物引起的）及其相关危害。这在HIV+患者中尤其如此 他们也是退伍军人关于HIV+个体中NMUPO的现有文献是有限的，因为它被绘制成 来自不可推广的人群;收集于早期的艾滋病毒治疗时代;并依赖于横断面 设计或有限的长期随访。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卓类药物）对NMUPO的影响及其后果很少。了解NMUPO模式 随着时间的推移，导致NMUPO升级的因素及其对健康结果的相关影响至关重要， 设计干预措施改善艾滋病毒阳性退伍军人的健康结果。我们的目标是利用现有的 退伍军人老龄化队列研究（VACS）中>2800名HIV+个体的纵向数据，以表征：1） NMUPO的重要轨迹，如使用升级，2）NMUPO轨迹之间的关联 和HIV相关的结果，以及3）NMUPO轨迹和死亡率之间的关联。VACS数据将 让我们在一组通过九个退伍军人事务部接受护理的艾滋病毒+患者中检查这些目标 美国各地的传染病诊所。自2005年以来，VACS已经收集了三个调查波， 自我报告的措施，包括使用全国药物使用和健康调查项目的NMUPO，疼痛， 抑郁症状和其他物质的使用。这些自我报告的数据将得到详细的补充， 通过电子病历提供的信息，包括处方（如阿片类药物和 苯二氮卓类）、医学和精神病学诊断（即PTSD）和实验室数据。与艾滋病毒有关的成果 包括VACS指数评分，这是一种来自常规实验室经验证的复合生物标志物， 总体艾滋病毒疾病的严重程度和准确预测死亡率;可检测的病毒载量和艾滋病毒护理的保留。 这项研究的创新之处包括它对从事常规医疗护理的患者的关注 在弗吉尼亚州（即美国最大的单一艾滋病毒提供者），评估NMUPO的能力， 同时提供详细的处方阿片类药物信息（包括持续时间、剂量、制剂）， 苯二氮卓类药物，以及一种纵向分析方法，该方法采用了双重结果轨迹模型， 评估NMUPO轨迹及其对重要健康结果的影响，包括VACS指数， mortality.这项工作由一个具有观察和干预专长的多学科小组进行， 研究，将提供必要的数据，为未来的筛查和治疗策略的发展提供信息， 在HIV+患者中降低风险并预防NMUPO和处方药的危害。

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.