title: Pain, mood, and substance abuse in HIV: implications for clinic visit utilization, antiretroviral therapy adherence, and virologic failure.
abstract: BACKGROUND
  Cooccurring pain, mood disorders, and substance abuse are common in HIV-infected patients. Our objective was to investigate the relationship between pain, alone and in the context of mood disorders and substance abuse, on clinic utilization, antiretroviral therapy adherence, and virologic suppression.
  
  
  METHODS
  Pain, mood disorders, and substance abuse were assessed at the first visit. No-show and urgent visits were measured over a 1-year period. Models were adjusted for age, race, sex, insurance status, CD4(+) T-lymphocyte count, and HIV risk factor.
  
  
  RESULTS
  Among 1521 participants, 509 (34%) reported pain, 239 (16%) had pain alone, 189 (13%) had pain and a mood disorder, and 30 (2%) had pain and substance abuse. In univariate models, participants with pain, mood disorders, and substance abuse had higher odds of a no-show visit than those without these conditions [odds ratio (OR), 1.4; 95% confidence interval (CI), 1.1-1.8; OR, 1.5; 95% CI, 1.2-1.9; OR, 2.0; 95% CI, 1.4-2.8, respectively]. In the multivariable model, pain increased the odds of a no-show visit only in participants without substance abuse (OR, 1.5; 95% CI, 1.1-1.9) and pain reduced the odds of a no-show visit in participants with substance abuse (OR, 0.5; 95% CI, 0.2-0.9; P for interaction = 0.0022).
  
  
  CONCLUSIONS
  In this study, pain increased the odds of no-show visits but only for participants without substance abuse. Because pain, mood disorders, and substance abuse are highly prevalent in HIV-infected patients, our findings have implications for HIV treatment success. Interventions that incorporate pain management may be important for improving health outcomes in patients living with HIV infection.
authors: Division of Infectious Diseases, Department of Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. jmerlin@uab.edu
authors: Jessica S
authors: JS
authors: Merlin
authors: Andrew O
authors: AO
authors: Westfall
authors: James L
authors: JL
authors: Raper
authors: Anne
authors: A
authors: Zinski
authors: Wynne E
authors: WE
authors: Norton
authors: James H
authors: JH
authors: Willig
authors: Robert
authors: R
authors: Gross
authors: Christine S
authors: CS
authors: Ritchie
authors: Michael S
authors: MS
authors: Saag
authors: Michael J
authors: MJ
authors: Mugavero
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D010146:Pain / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D017211:Treatment Failure; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents