HIV 感染和未感染患者的阿片类镇痛药的使用情况。
Receipt of opioid analgesics by HIV-infected and uninfected patients.
机构信息
Department of Internal Medicine, Yale University School of Medicine, PO Box 208093, New Haven, CT 06520-8088, USA.
出版信息
J Gen Intern Med. 2013 Jan;28(1):82-90. doi: 10.1007/s11606-012-2189-z. Epub 2012 Aug 16.
BACKGROUND
Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status.
OBJECTIVES
To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids.
DESIGN
Cross-sectional analysis of the Veterans Aging Cohort Study.
PARTICIPANTS
HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls.
MAIN MEASURES
Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥ 120 mg of morphine equivalents; long-term opioids was defined as ≥ 90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes.
KEY RESULTS
Among the HIV+ (n = 23,651) and uninfected (n = 55,097) patients, 31 % of HIV+ and 28 % of uninfected (p < 0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p = 0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p < 0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p < 0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p < 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01).
CONCLUSIONS
Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.
背景
阿片类药物的使用日益增多，但有关艾滋病毒感染者接受阿片类药物的情况的数据有限。
目的
描述艾滋病毒感染者接受阿片类药物的模式，以及艾滋病毒感染者与接受任何剂量、高剂量和长期阿片类药物之间的关系。
设计
退伍军人老龄化队列研究的横断面分析。
参与者
接受退伍军人健康管理局医疗服务的艾滋病毒感染者（HIV+）患者和未感染的匹配对照。
主要措施
使用 ICD-9 代码确定与疼痛相关的诊断。任何阿片类药物的使用都定义为至少有一次阿片类药物处方；高剂量定义为平均每日剂量≥120 毫克吗啡当量；长期阿片类药物定义为连续 90 天以上，允许 30 天的续药期。使用多变量模型评估 HIV 感染与三种结局之间的关系。
主要结果
在 HIV+（n=23651）和未感染（n=55097）患者中，31%的 HIV+患者和 28%的未感染患者（p<0.001）接受了阿片类药物。在接受阿片类药物的患者中，HIV+患者更有可能出现急性疼痛诊断（7%比 4%），但更不可能出现慢性疼痛诊断（53%比 69%）。与未感染患者相比，HIV+患者接受的平均每日吗啡当量剂量更高（41 毫克比 37 毫克，p=0.001），更有可能接受高剂量阿片类药物（6%比 5%，p<0.001）。与未感染患者相比，HIV+患者接受的阿片类药物天数更少（中位数 44 天比 60 天，p<0.001），更不可能接受长期阿片类药物（31%比 34%，p<0.001）。多变量分析显示，HIV+状态与接受任何阿片类药物（AOR 1.40，95%CI 1.35，1.46）和高剂量阿片类药物（AOR 1.22，95%CI 1.07，1.39）有关，但与长期阿片类药物无关（AOR 0.94，95%CI 0.88，1.01）。
结论
与未感染个体相比，感染艾滋病毒的患者更有可能开阿片类药物，并且与疼痛诊断存在不同的关联。在这个高度复杂和脆弱的患者群体中，可能需要努力使疼痛管理方法标准化。
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