title: The impact of prescribed opioids on CD4 cell count recovery among HIV-infected patients newly initiating antiretroviral therapy.
abstract: Certain prescribed opioids have immunosuppressive properties, yet their impact on clinically relevant outcomes, including antiretroviral therapy (ART) response among HIV-infected patients, remains understudied.
  
  
  
  Using the Veterans Aging Cohort Study data, we conducted a longitudinal analysis of 4358 HIV-infected patients initiating ART between 2002 and 2010 and then followed them for 24 months. The primary independent variable was prescribed opioid duration, categorized using pharmacy data as none prescribed, short-term (< 90 days) and long-term (≥ 90 days). Outcomes included CD4 cell count over time. Analyses adjusted for demographics, comorbid conditions, ART type and year of initiation, and overall disease severity [ascertained with the Veterans Aging Cohort Study (VACS) Index]. Sensitivity analyses examined whether effects varied according to baseline CD4 cell count, achievement of viral load suppression, and opioid properties (i.e. dose and known immunosuppressive properties).
  
  
  
  Compared to those with none, patients with short-term opioids had a similar increase in CD4 cell count (mean rise per year: 74 vs. 68 cells/μL; P = 0.11), as did those with long-term prescribed opioids (mean rise per year: 74 vs. 75 cells/μL; P = 0.98). In sensitivity analysis, compared with no opioids, the effects of short-term prescribed opioids were statistically significant among those with a baseline CD4 cell count ≥ 500 cells/μL (mean rise per year: 52 cells/μL for no opioids vs. 20 cells/μL for short-term opioids; P = 0.04); findings were otherwise unchanged.
  
  
  
  Despite immunosuppressive properties intrinsic to opioids, prescribed opioids appeared to have no effect on CD4 cell counts over 24 months among HIV-infected patients initiating ART.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA. ejennifer.edelman@yale.edu.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA. ejennifer.edelman@yale.edu.
authors.forename: E J
authors.initials: EJ
authors.lastname: Edelman
authors.affiliation: VA Connecticut Health Care System, West Haven, CT, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Gordon
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.|VA Connecticut Health Care System, West Haven, CT, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Tate
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.|VA Connecticut Health Care System, West Haven, CT, USA.
authors.forename: W C
authors.initials: WC
authors.lastname: Becker
authors.affiliation: National Institute on Alcohol Abuse and Alcoholism, HIV/AIDS Program, Bethesda, MD, USA.
authors.forename: K
authors.initials: K
authors.lastname: Bryant
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Crothers
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.|VA Connecticut Health Care System, West Haven, CT, USA.|Yale University School of Public Health, New Haven, CT, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Gaither
authors.affiliation: DC Veterans Affairs Medical Center and George Washington University, Washington, DC, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Gibert
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: Brown University School of Public Health, Providence, RI, USA.
authors.forename: Bdl
authors.initials: B
authors.lastname: Marshall
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.affiliation: Boston University Schools of Medicine and Public Health, Boston, MA, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: VA Connecticut Health Care System, West Haven, CT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Skanderson
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.|VA Connecticut Health Care System, West Haven, CT, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
chemical_list: D000701:Analgesics, Opioid; D044966:Anti-Retroviral Agents; D007166:Immunosuppressive Agents
keywords: 
  HIV
  ; CD4 lymphocyte count; analgesics; antiretroviral therapy; disease progression; opioid