Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT.
J Acquir Immune Defic Syndr. 2020 May 1;84(1):26-36. doi: 10.1097/QAI.0000000000002310.
No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of self-reported opioid use and their correlates among a national sample of PWH engaged in care.
Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at 8 US Veterans Health Administration (VA) sites.
Between 2002 and 2018, we assessed past year opioid use frequency based on self-reported "prescription painkillers" and/or heroin use at baseline and follow-up. We used group-based trajectory models to identify opioid use trajectories and multinomial logistic regression to determine baseline factors independently associated with escalating opioid use compared to stable, infrequent use.
Among 3702 PWH, we identified 4 opioid use trajectories: (1) no lifetime use (25%); (2) stable, infrequent use (58%); (3) escalating use (7%); and (4) de-escalating use (11%). In bivariate analysis, anxiety; pain interference; prescribed opioids, benzodiazepines and gabapentinoids; and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. In multivariable analysis, illness severity, pain interference, receipt of prescribed benzodiazepine medications, and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use.
Among PWH engaged in VA care, 1 in 15 reported escalating opioid use. Future research is needed to understand the impact of psychoactive medications and marijuana use on opioid use and whether enhanced uptake of evidence-based treatment of pain and psychiatric symptoms can prevent escalating use among PWH.
既往研究并未明确 HIV 感染者（PWH）无论阿片类药物来源或使用原因，其长期阿片类药物使用模式。我们旨在确定参与治疗的 PWH 全国性样本中自我报告的阿片类药物使用轨迹及其相关因素。
退伍军人老龄化队列研究，一项包括在 8 个美国退伍军人事务部（VA）地点接受治疗的 PWH 的前瞻性队列研究。
在 2002 年至 2018 年期间，我们根据基线和随访时自我报告的“处方止痛药”和/或海洛因使用情况评估了过去一年的阿片类药物使用频率。我们使用基于群组的轨迹模型来确定阿片类药物使用轨迹，并使用多项逻辑回归来确定与稳定、不频繁使用相比，与升级阿片类药物使用独立相关的基线因素。
在 3702 名 PWH 中，我们确定了 4 种阿片类药物使用轨迹：（1）终身无使用（25%）；（2）稳定、不频繁使用（58%）；（3）递增使用（7%）；（4）递减使用（11%）。在单变量分析中，焦虑、疼痛干扰、开处阿片类药物、苯二氮䓬类药物和加巴喷丁类药物以及大麻使用与稳定、不频繁使用相比，与递增阿片类药物使用组有关。在多变量分析中，与稳定、不频繁使用相比，疾病严重程度、疼痛干扰、接受苯二氮䓬类药物治疗和大麻使用与递增阿片类药物使用组有关。
在接受 VA 治疗的 PWH 中，有 1/15 报告阿片类药物使用增加。需要进一步研究来了解精神活性药物和大麻使用对阿片类药物使用的影响，以及是否可以通过加强疼痛和精神症状的循证治疗来预防 PWH 中阿片类药物的递增使用。
