Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD.
J Acquir Immune Defic Syndr. 2018 Jul 1;78(3):283-290. doi: 10.1097/QAI.0000000000001690.
Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals.
We analyzed clinical and demographic data from the HIV Research Network and prescribing data from Medicaid for noncancer patients seeking HIV treatment at 4 urban clinics between 2006 and 2010.
HIV Research Network patients were included in the analytic sample if they received at least one incident opioid prescription. We examined 4 measures of high-risk opioid use: (1) high daily dosage; (2) early refills; (3) overlapping prescriptions; and (4) multiple prescribers.
Of 4605 eligible PLWH, 1814 (39.4%) received at least one incident opioid prescription during follow-up. The sample was 61% men and 62% African American with a median age of 44.5 years. High-risk opioid use occurred among 30% of incident opioid users (high daily dosage: 7.9%; early refills: 15.9%; overlapping prescriptions: 16.4%; and multiple prescribers: 19.7%). About half of the cumulative incidence of high-risk use occurred within 1 year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with injection drug use as an HIV risk factor [adjusted hazard ratio (aHR) = 1.39, 95% confidence interval: 1.11 to 1.74], non-Hispanic whites [aHR = 1.61, (1.21 to 2.14)], patients age 35-45 [aHR = 1.94, (1.33 to 2.80)] and 45-55 [aHR = 1.84, (1.27 to 2.67)], and patients with a diagnosis of chronic pain [aHR = 1.32, (1.03 to 1.70)].
A large proportion of PLWH received opioid prescriptions, and among these opioid recipients, high-risk opioid use was common. High-risk use patterns often occurred within the first year, suggesting this is a critical time for intervention.
在感染艾滋病毒（HIV）的人群（PLWH）中，处方类阿片类药物的使用更为普遍，但对于这些人群中特定类型的高危使用的流行程度知之甚少。
我们分析了 2006 年至 2010 年间，4 家城市诊所内的 HIV 研究网络的临床和人口统计学数据，以及 Medicaid 针对非癌症患者接受 HIV 治疗的处方数据。
如果 HIV 研究网络患者至少接受过一次阿片类药物处方，那么他们就被纳入分析样本。我们研究了四种高危阿片类药物使用情况的衡量标准：（1）高日剂量；（2）提前续方；（3）处方重叠；（4）多个处方医生。
在 4605 名符合条件的 PLWH 中，有 1814 名（39.4%）在随访期间至少接受过一次阿片类药物处方。该样本中 61%为男性，62%为非裔美国人，中位年龄为 44.5 岁。高危阿片类药物使用发生在 30%的阿片类药物使用者中（高日剂量：7.9%；提前续方：15.9%；处方重叠：16.4%；多个处方医生：19.7%）。大约一半的高危使用的累积发生率发生在接受阿片类药物处方后的 1 年内。在调整了研究地点后，具有注射吸毒作为 HIV 风险因素的患者（调整后的危险比[aHR]：1.39，95%置信区间：1.11 至 1.74）、非西班牙裔白人（aHR：1.61，1.21 至 2.14）、年龄在 35-45 岁的患者（aHR：1.94，1.33 至 2.80）和 45-55 岁的患者（aHR：1.84，1.27 至 2.67），以及患有慢性疼痛诊断的患者（aHR：1.32，1.03 至 1.70），高危阿片类药物使用更为常见。
很大一部分 PLWH 收到了阿片类药物处方，而在这些阿片类药物使用者中，高危阿片类药物使用较为常见。高危使用模式通常发生在第一年，这表明这是干预的关键时期。
