Do prescription opioids increase the risk of pneumonia in HIV patients? 

Drugs
prescription opioids

A new study in JAMA Internal Medicine accessed data from over 25000 patients to analyze the risk of community-acquired pneumonia in both non-HIV and HIV patients using opioids as painkillers.

 

People with HIV suffer severe immune deficiencies that compromise their body’s ability to fight pathological conditions, making them prone to a wide spectrum of painful diseases such as – infections, cancers and nerve damage. This is often associated with persistent pain in patients due to the development of one or more of these painful conditions. HIV patients with chronic pain are commonly treated with prescription opioids, which are a class of drugs that reduce pain by blocking pain receptors in brain, spinal cord and other parts of the body.

Opioids can weaken the immune system

Many studies have shown that long-term or high-dosage use of some prescription opioids can substantially weaken the immune system (immunosuppressive opioids). This in turn, makes the patient’s prone to different type of diseases, including bacterial infections like pneumonia. The problem can be worsened in patients with HIV, who already have a severely compromised immune system. Therefore there are many investigations that are ongoing, which aim to analyze the effects of prescription opioids and the risk of acquiring other diseases such as pneumonia.

Opioid use is correlated is to increased risk of pneumonia in both non-HIV and HIV patients

The researchers at the Yale University, in New Haven, Connecticut, U.S.A, analyzed data from over 25000 patients who received treatment from January 1, 2000, through December 31, 2012, at the Veterans Health Administration (VA) medical centers across the country.

Patients with and without pneumonia were classified on basis of age, sex, race, and HIV status. Patients were also stratified based on based on the length of opioid use, the dose, and whether the prescription opioid they are using is known to be immunosuppressive. 4246 patients with pneumonia were compared with 21146 patients that did not have this disease. The results of this study were published in JAMA Internal Medicine.

The study revealed that medium to high dose use of prescription opioids was correlated with significantly increased risk of pneumonia. The risk was worse for patients that took immunosuppressive opioids. HIV patients were more susceptible to pneumonia even at a lower dose of prescription opioids. The authors warned that it is important to monitor the dose of prescription opioids administered to the patients and suggested increasing vaccination as a reform to combat the risk of acquiring this disease.

Written by Vinayak Khattar, Ph.D., M.B.A

Reference: Edelman, E. J., Gordon, K. S., Crothers, K., Akgun, K., Bryant, K. J., Becker, W. C., . . . Fiellin, D. A. (2019). Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV. JAMA Intern Med. doi:10.1001/jamainternmed.2018.6101

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