Division of Infectious Diseases, Department of Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
J Acquir Immune Defic Syndr. 2012 Oct 1;61(2):164-70. doi: 10.1097/QAI.0b013e3182662215.
Cooccurring 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 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 1-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 those without these conditions [odds ratio (OR), 1.4; 95% confidence interval (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.
在 HIV 感染者中，同时存在疼痛、情绪障碍和物质滥用较为常见。我们的目的是研究疼痛（单独存在和与情绪障碍及物质滥用同时存在的情况下）与就诊利用度、抗逆转录病毒治疗依从性和病毒学抑制之间的关系。
在首次就诊时评估疼痛、情绪障碍和物质滥用情况。在 1 年期间测量未就诊和紧急就诊的情况。模型调整了年龄、种族、性别、保险状况、CD4+T 淋巴细胞计数和 HIV 风险因素。
在 1521 名参与者中，509 名（34%）报告存在疼痛，239 名（16%）仅有疼痛，189 名（13%）既有疼痛又有情绪障碍，30 名（2%）既有疼痛又有物质滥用。在单变量模型中，有疼痛、情绪障碍和物质滥用的参与者与无这些情况的参与者相比，未就诊就诊的可能性更高[比值比（OR），1.4；95%置信区间（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，疼痛仅在无物质滥用的参与者中增加了未就诊就诊的可能性（OR，1.5；95%CI，1.1-1.9），而疼痛降低了有物质滥用的参与者未就诊就诊的可能性（OR，0.5；95%CI，0.2-0.9；P 交互=0.0022）。
在这项研究中，疼痛增加了未就诊就诊的可能性，但仅限于无物质滥用的参与者。由于疼痛、情绪障碍和物质滥用在 HIV 感染者中非常普遍，因此我们的发现对 HIV 治疗成功具有重要意义。纳入疼痛管理的干预措施可能对改善 HIV 感染者的健康结局非常重要。
