title: Factors associated with initiation of prolonged analgesic use among patients in the HIV Outpatient Study (HOPS).
abstract: BACKGROUND
  Analgesic use is common but remains poorly described among human immunodeficiency virus (HIV)-infected persons in the highly active antiretroviral therapy era.
  
  
  METHODS
  We studied HIV Outpatient Study participants during 1996 to 2008. We used Cox proportional hazards regression to assess variables associated with initiation of prolonged analgesia (≥90 consecutive days of analgesics); logistic regression to explore variables associated with initiation of prolonged opioid analgesia among those taking any prolonged analgesia; and linear regression to determine temporal trends in prolonged analgesia.
  
  
  RESULTS
  Among 4180 patients, 931 (22%) initiated prolonged analgesia. Factors independently associated (P<0.05) with prolonged analgesia included: age above 40 years (hazard ratio=1.20), female sex (1.43), injection drug use as an HIV risk factor (1.33), public healthcare payer (1.88), nadir CD4+ less than 200 cells/mm (1.29), tobacco use (1.43), prior opportunistic infection(s) (1.25), antidepressant use (1.76), and anxiolytic use (1.51). Independent correlates of prolonged opioid analgesia were white race (odds ratio=1.64), baseline CD4+ less than 350 cells/mm (1.88), and anxiolytic use (1.87). Prolonged analgesia ranged from 11% to 15% each year.
  
  
  CONCLUSIONS
  In the highly active antiretroviral therapy era, up to 15% of HIV Outpatient Study patients used prolonged analgesic therapy each year. Variables associated with the initiation of prolonged analgesia included HIV and non-HIV-related factors.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, USA. John.Koeppe@ucdenver.edu
authors.forename: John
authors.initials: J
authors.lastname: Koeppe
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lichtenstein
authors.forename: Carl
authors.initials: C
authors.lastname: Armon
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.forename: Kathy
authors.initials: K
authors.lastname: Wood
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count / Q000379:methods; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008297:Male; D010045:Outpatients; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000821:virology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load; D014764:Viral Proteins / Q000235:genetics / Q000378:metabolism
chemical_list: D000700:Analgesics; D019380:Anti-HIV Agents; D014764:Viral Proteins