Prescription Opioid Use and Virologic Failure Among People Living With HIV

People living with HIV (PLWH) experience an increased burden of chronic pain and have high rates of prescription opioid use, including long-term opioid therapy (LTOT). The relationship between prescription opioid use, chronic pain and LTOT on HIV treatment outcomes was examined in two cohort studies of PLWH. Flores et al. evaluated the association between appearance of a prescription for an opioid in the electronic medical record and virologic failure (defined as HIV RNA ≥ 200 copies/mL) among a cohort of 1907 PLWH receiving HIV medical care in Texas.

  • The median age was 45 years; 76% were male, 62% were Hispanic, 56% were men who have sex with men, 83% were prescribed anti-retroviral therapy (ART), and 33% had HIV RNA >200 copies/mL.
  • While no current illicit drug use was reported by 58% of study participants, such data was missing for 34% of patients.
  • 26% of study participants had an opioid prescription.
  • An opioid prescription was associated with virologic failure (adjusted odds ratio [aOR], 1.34).

Merlin et al. evaluated the association between chronic pain and LTOT (defined as >90 consecutive days of an opioid prescription in the medical record) and HIV treatment outcomes, including retention in primary care and virologic failure (defined as HIV RNA >1000 copies/mL) among 2334 individuals receiving medical care at 5 HIV primary care clinics.

  • Participants were predominantly male, white, middle aged, and 12% had HIV RNA >1000 copies/mL.
  • Among all cohort participants, 25% reported chronic pain and 15% were prescribed LTOT.
  • Among participants not receiving LTOT, chronic pain was associated with virologic failure (aOR,1.97).
  • Among participants with chronic pain, LTOT was associated with lower rates of virologic failure (aOR, 0.56).

Comments: These studies offer seemingly contradictory findings. But there were substantial differences between both cohorts making a comparison difficult. And data on illicit/non-medical use of opioids was limited and neither study accounted for ART adherence to ART. Despite these significant limitations, it seems clear that caution is warranted when prescribing opioids but that some patients receive benefit.

Jeffrey Morgan, MA† & Seonaid Nolan, MD

†Contributing Editorial Intern and Research Coordinator, BC Centre on Substance Use


Flores J, Liang Y, Ketchum NS, et al. Prescription opioid use is associated with virologic failure in people living with HIV. AIDS Behav. 2018;22:1323–1328.

Merlin JS, Long D, Becker WC, et al. Brief report: the association of chronic pain and long-term opioid therapy with HIV treatment outcomes. J Acquir Immune Defic Syndr. 2018;79:1:77–82.

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