Long-term Prescription of Opioids and/or Benzodiazepines and Mortality Among HIV-Infected and Uninfected Patients

被引：66

作者：

Weisberg, Daniel F. ^{[1
]}

Gordon, Kirsha S. ^{[2
]}

Barry, Declan T. ^{[3
]}

Becker, William C. ^{[4
]}

Crystal, Stephen ^{[5
]}

Edelman, Eva J. ^{[4
,6
]}

Gaither, Julie ^{[7
]}

Gordon, Adam J. ^{[8
,9
]}

Goulet, Joseph ^{[2
,10
]}

Kerns, Robert D. ^{[2
,10
]}

Moore, Brent A. ^{[2
,6
,10
]}

Tate, Janet ^{[2
,4
]}

Justice, Amy C. ^{[2
,4
,6
]}

Fiellin, David A. ^{[4
,6
]}

机构：

[1] Yale Univ, Sch Med, New Haven, CT 06510 USA

[2] VA Connecticut Healthcare Syst, West Haven, CT USA

[3] Yale Univ, Sch Med, Dept Psychiat, New Haven, CT 06510 USA

[4] Yale Univ, Sch Med, Dept Internal Med, ES Harkness Bldg A,367 Cedar St,Suite 406A, New Haven, CT 06510 USA

[5] Rutgers State Univ, Inst Hlth Hlth Care Policy & Aging Res, New Brunswick, NJ 08903 USA

[6] Yale Univ, Sch Publ Hlth, Ctr Interdisciplinary Res AIDS, New Haven, CT 06510 USA

[7] Yale Univ, Sch Publ Hlth, New Haven, CT 06510 USA

[8] Univ Pittsburgh, Sch Med, Dept Med, Pittsburgh, PA 15213 USA

[9] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA

[10] VA Connecticut Healthcare Syst, Pain Res Informat Multimorbid & Educ PRIME Ctr, West Haven, CT USA

来源：

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES | 2015年 / 69卷 / 02期

关键词：

opioid analgesics; benzodiazepines; HIV; pharmacoepidemiology; polypharmacy; HUMAN-IMMUNODEFICIENCY-VIRUS; VETERANS AGING COHORT; PROBLEM DRUG-USE; NONCANCER PAIN; COMPARATIVE SAFETY; ANXIETY DISORDERS; NONMALIGNANT PAIN; PROPENSITY SCORES; OLDER-ADULTS; BACK-PAIN;

D O I：

10.1097/QAI.0000000000000591

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: Increased long-term prescription of opioids and/or benzodiazepines necessitates evaluating risks associated with their receipt. We sought to evaluate the association between long-term opioids and/or benzodiazepines and mortality in HIV-infected patients receiving antiretroviral therapy and uninfected patients. Methods: Prospective analysis of all-cause mortality using multivariable methods and propensity score matching among HIV-infected patients receiving antiretroviral therapy and uninfected patients. Results: Of 64,602 available patients (16,989 HIV-infected and 47,613 uninfected), 27,128 (exposed and unexposed to long-term opioids and/or benzodiazepines) were 1: 1 matched by propensity score. The hazard ratio for death was 1.40 [95% confidence interval (CI): 1.22 to 1.61] for long-term opioid receipt, 1.26 (95% CI: 1.08 to 1.48) for long-term benzodiazepine receipt, and 1.56 (95% CI: 1.26 to 1.92) for long-term opioid and benzodiazepine receipt. There was an interaction (P = 0.01) between long-term opioid receipt and HIV status with mortality. For long-term opioid receipt, the hazard ratio was 1.46 (95% CI: 1.15 to 1.87) among HIV-infected patients, and 1.25 (95% CI: 1.05 to 1.49) among uninfected patients. Mortality risk was increased for patients receiving both long-term opioids and benzodiazepines when opioid doses were >= 20 mg morphine-equivalent daily dose and for patients receiving long-term opioids alone when doses were >= 50 mg morphine-equivalent daily dose. Conclusions: Long-term opioid receipt was associated with an increased risk of death; especially with long-term benzodiazepine receipt, higher opioid doses, and among HIV-infected patients. Long-term benzodiazepine receipt was associated with an increased risk of death regardless of opioid receipt. Strategies to mitigate risks associated with these medications, and caution when they are coprescribed, are needed particularly in HIV-infected populations.

引用

页码：223 / 233

页数：11

共 77 条

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