HIV Medication Adherence Is Not Improved by Prescription Opioid Pain Medication, Worse Among People With Nonmedical Use of Prescription Opioids

Pain, prescribed opioid pain medication, and nonmedical use of prescription opioids use are common in people with HIV infection. Researchers conducted a prospective cohort study among 258 people with HIV to determine whether pain severity was associated with worse anti-retroviral therapy (ART) adherence, whether taking opioids for pain as prescribed was associated with better ART adherence, and the association between nonmedical use of prescription opioids and ART adherence.

• Over the last week, 48% of participants reported severe pain and 34% reported moderate pain; opioid medication for pain was prescribed to 53% of the cohort.
• Nonmedical use of prescription opioids was reported by 21% of participants.
• Severe pain was associated with worse ART adherence in unadjusted analyses (odds ratio [OR], 1.37), but not in analyses adjusted for homelessness severity, self-rated health, depression, illicit substance use, and nonmedical use of prescription opioids.
• Receiving prescribed opioid medication for pain was not associated with worse adherence in unadjusted (OR, 1.40) or adjusted analyses.
• Nonmedical use of prescription opioids was associated with worse adherence in unadjusted (OR, 1.70) and adjusted (OR, 1.47) analyses.

Comments:

This study confirms that nonmedical use of prescription opioids, like other unhealthy substance use, is associated with worse ART adherence. It does not confirm that treating pain with opioids improves ART adherence. Determining which patients with HIV infection and pain benefit from prescribed opioids more than they are harmed remains a clinical dilemma that warrants further prospective research into identifying modifiable risk factors and treatment approaches.

Alexander Y. Walley, MD, MSc

Reference:

Jeevanjee S, Penko J, Guzman D, et al. Opioid analgesic misuse is associated with incomplete antiretroviral adherence in a cohort of HIV-infected indigent adults in San Francisco. AIDS Behav. 2014;18(7):1352–1358.