Opioid use trajectory groups and changes in a physical health biomarker among HIV-positive and uninfected patients receiving opioid agonist treatment

For the VACS Project Group

Research output: Contribution to journalArticle

Abstract

Background: Objective outcomes for measuring the physical health effects of substance use disorder treatment are needed. We compared the responsiveness of CD4, HIV-1 RNA and a biomarker index (VACS Index 2.0) to changes in opioid use among people with HIV (PWH) and uninfected individuals receiving opioid agonist treatment (OAT). Methods: Electronic health record data were used to identify patients who received ≥90 days of OAT and had ≥1 urine toxicology test in the Veterans Aging Cohort Study. Trajectory models identified patterns of opioid urine toxicology results. We used linear regression adjusted for age and race/ethnicity to determine associations between opioid toxicology groups and biomarker changes from up to one-year pre OAT to 3–15 months after OAT initiation. Results: Among 266 with detectable HIV-1 RNA, 366 with suppressed HIV-1 RNA, and 1183 uninfected patients, we identified five opioid toxicology groups ranging from consistently negative (54%) to consistently positive (9%). Among PWH with detectable HIV-1 RNA, all three biomarkers improved more for those consistently negative compared to those consistently positive (all p < .05). Among PWH with suppressed HIV-1 RNA, CD4 improved for those consistently negative; and worsened for those in the slow decrease toward negative group (p = .04). Among those uninfected, VACS Index 2.0 did not differ by opioid toxicology groups. Conclusions: Among patients on OAT, changes in biomarkers are associated with opioid toxicology groups among PWH, but vary by HIV-1 RNA. These findings may be useful for measuring the health effects of OAT.

Original languageEnglish (US)
Article number107511
JournalDrug and alcohol dependence
Volume204
DOIs
StatePublished - Nov 1 2019

Fingerprint

Biomarkers
Opioid Analgesics
Trajectories
Health
HIV
Toxicology
HIV-1
RNA
Therapeutics
Urine
Electronic Health Records
Veterans
Linear regression
Substance-Related Disorders
Linear Models
Cohort Studies
Aging of materials

Keywords

  • Buprenorphine
  • CD4
  • HIV
  • HIV-1 RNA
  • Methadone
  • VACS index

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Opioid use trajectory groups and changes in a physical health biomarker among HIV-positive and uninfected patients receiving opioid agonist treatment. / For the VACS Project Group.

In: Drug and alcohol dependence, Vol. 204, 107511, 01.11.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Objective outcomes for measuring the physical health effects of substance use disorder treatment are needed. We compared the responsiveness of CD4, HIV-1 RNA and a biomarker index (VACS Index 2.0) to changes in opioid use among people with HIV (PWH) and uninfected individuals receiving opioid agonist treatment (OAT). Methods: Electronic health record data were used to identify patients who received ≥90 days of OAT and had ≥1 urine toxicology test in the Veterans Aging Cohort Study. Trajectory models identified patterns of opioid urine toxicology results. We used linear regression adjusted for age and race/ethnicity to determine associations between opioid toxicology groups and biomarker changes from up to one-year pre OAT to 3–15 months after OAT initiation. Results: Among 266 with detectable HIV-1 RNA, 366 with suppressed HIV-1 RNA, and 1183 uninfected patients, we identified five opioid toxicology groups ranging from consistently negative (54{\%}) to consistently positive (9{\%}). Among PWH with detectable HIV-1 RNA, all three biomarkers improved more for those consistently negative compared to those consistently positive (all p < .05). Among PWH with suppressed HIV-1 RNA, CD4 improved for those consistently negative; and worsened for those in the slow decrease toward negative group (p = .04). Among those uninfected, VACS Index 2.0 did not differ by opioid toxicology groups. Conclusions: Among patients on OAT, changes in biomarkers are associated with opioid toxicology groups among PWH, but vary by HIV-1 RNA. These findings may be useful for measuring the health effects of OAT.",
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AU - McGinnis, Kathleen A.

AU - Fiellin, David A.

AU - Skanderson, Melissa

AU - Hser, Yih Ing

AU - Lucas, Gregory M

AU - Justice, Amy C.

AU - Tate, Janet P.

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KW - Buprenorphine

KW - CD4

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