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Long-term Patterns of Self-reported Opioid Use, VACS Index, and Mortality Among People with HIV Engaged in Care

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Abstract

Longitudinal analyses of opioid use and overall disease severity among people with HIV (PWH) are lacking. We used joint-trajectory and Cox proportional hazard modeling to examine the relationship between self-reported opioid use and the Veterans Aging Cohort Study (VACS) Index 2.0, a validated measure of disease severity and mortality, among PWH engaged in care. Using data from 2002 and 2018, trajectory modeling classified 20% of 3658 PWH in low (i.e., lower risk of mortality), 40% in moderate, 28% in high, and 12% in extremely high VACS Index trajectories. Compared to those with moderate VACS Index trajectory, PWH with an extremely high trajectory were more likely to have high, then de-escalating opioid use (adjusted odds ratio [AOR], 95% confidence interval [CI] 5·17 [3·19–8·37]) versus stable, infrequent use. PWH who report high frequency opioid use have increased disease severity and mortality risk over time, even when frequency of opioid use de-escalates.

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Data Availability

A de-identified data set can be made available upon written request and approval by VACS leadership.

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Acknowledgements

We would like to acknowledge the veterans who participate in the Veterans Aging Cohort Study (VACS) and the study coordinators and staff at each VACS site and at the West Haven Coordinating Center. We would also like to thank Dr. Bobby Jones for his assistance with the joint-trajectory modeling procedures. The authors declare that they have no conflict of interest. This work was supported by supported by the National Institute on Drug Abuse (5R01DA040471-03), National Institute on Alcohol Abuse and Alcoholism (U10-AA13566), National Institute of Mental Health (F31-MH114736-01A1), and National Institute of Allergy and Infectious Diseases (T32-AI052074).

Funding

This work was supported by the National Institute on Drug Abuse (5R01DA040471-03, R25-DA037190), National Institute on Alcohol Abuse and Alcoholism (U10-AA13566), National Institute of Mental Health (F31-MH114736-01A1), and National Institute of Allergy and Infectious Diseases (T32-AI052074).

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Authors and Affiliations

  1. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Joëlla W. Adams, Yu Li & Brandon D. L. Marshall

  2. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Declan T. Barry & Robert D. Kerns

  3. VA Connecticut Healthcare Systems, West Haven, CT, USA

    Kirsha S. Gordon, Robert D. Kerns & Christopher T. Rentsch

  4. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA

    Kirsha S. Gordon, Benjamin J. Oldfield & E. Jennifer Edelman

  5. Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK

    Christopher T. Rentsch

  6. Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 367 Cedar Street, ES Harkness, Suite 401, New Haven, CT, 06510, USA

    E. Jennifer Edelman

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  1. Joëlla W. Adams
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  2. Yu Li
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  8. Brandon D. L. Marshall
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  9. E. Jennifer Edelman
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Contributions

JWA, YL, BDLM, and EJE conceptualized this specific analysis. YL performed the formal analysis. JWA and EJE wrote the resulting manuscript while YL, DTB, KSG, RDK, BO, CTR, and BDLM provided feedback and edits. All authors reviewed and approved submission.

Corresponding author

Correspondence to E. Jennifer Edelman.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

VACS received approval from the Institutional Review Boards at Yale University, VA Connecticut Healthcare System, and each participating site.

Informed Consent

All participants gave written informed consent.

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Adams, J.W., Li, Y., Barry, D.T. et al. Long-term Patterns of Self-reported Opioid Use, VACS Index, and Mortality Among People with HIV Engaged in Care. AIDS Behav 25, 2951–2962 (2021). https://doi.org/10.1007/s10461-021-03162-7

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