Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV

Abstract

IMPORTANCE Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV.OBJECTIVE To assess the association of prescribed opioids with community-acquired pneumonia (CAP) by opioid properties and HIV status. DESIGN, SETTING, AND PARTICIPANTSThis nested case-control study used data from patients in the Veterans Aging Cohort Study (VACS) from January 1, 2000, through December 31, 2012. Participants in VACS included patients living with and without HIV who received care in Veterans Health Administration (VA) medical centers across the United States. Patients with CAP requiring hospitalization (n = 4246) were matched 1:5 with control individuals without CAP (n = 21 146) by age, sex, race/ethnicity, length of observation, and HIV status. Data were analyzed from March 15, 2017, through August 8, 2018.EXPOSURES Prescribed opioid exposure during the 12 months before the index date was characterized by a composite variable based on timing (none, past, or current); low (<20 mg), medium (20-50 mg), or high (>50 mg) median morphine equivalent daily dose; and opioid immunosuppressive properties (yes vs unknown or no). MAIN OUTCOME AND MEASURE CAP requiring hospitalization based on VA and Centers for Medicare & Medicaid data.RESULTS Among the 25 392 VACS participants (98.9% male; mean [SD] age, 55 [10] years), current medium doses of opioids with unknown or no immunosuppressive properties (adjusted odds ratio [AOR], 1.35; 95% CI, 1.13-1.62) and immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and current high doses of opioids with unknown or no immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and immunosuppressive properties (AOR, 3.18; 95% CI, 2.44-4.14) were associated with the greatest CAP risk compared with no prescribed opioids or any past prescribed opioid with no immunosuppressive (AOR, 1.24; 95% CI, 1.09-1.40) and immunosuppressive properties (AOR, 1.42; 95% CI, 1.21-1.67), especially with current receipt of immunosuppressive opioids. In stratified analyses, CAP risk was consistently greater among people living with HIV with current prescribed opioids, especially when prescribed immunosuppressive opioids (eg, AORs for current immunosuppressive opioids with medium dose, 1.76 [95% CI, 1.20-2.57] vs 2.33 [95% CI, 1.60-3.40]).CONCLUSIONS AND RELEVANCE Prescribed opioids, especially higher-dose and immunosuppressive opioids, are associated with increased CAP risk among persons with and without HIV.

Hospital-Treated Pneumonia Associated with Opioid Use Among Community Dwellers with Alzheimer’s Disease

“…Our main result, that opioid use is associated with an increased risk of pneumonia, is supported by previous studies [13][14][15][16][17]. Opioid use has been associated with a higher risk of pneumonia among older community-dwelling people [13], people with rheumatoid arthritis [15], COPD [14], Medicaid beneficiaries [16] and, more recently, among veterans with and without HIV [17]. Similarly, a higher risk of pneumonia-related mortality has been previously described among opium users [32].…”

“…In our sub-analyses, previous categorization as immunosuppressive opioid agents was associated with a lower risk of pneumonia compared to nonimmunosuppressive opioids. It should be noted, however, that the doses of opioids used in our study were relatively low and the used opioids somewhat different compared to previous studies [13][14][15][16][17]. These factors, as well as different study populations, may explain some of the dissimilarities in the results.…”

“…Previous research has associated opioid use with a higher risk of pneumonia in different population groups [13][14][15][16][17]. However, the risk of pneumonia among opioid users with cognitive disorders has not been studied previously.…”

Management of Osteoarthritis During the COVID‐19 Pandemic

“…88 A group of them (i.e., morphine, fentanyl, and remifentanil) was described as immunosuppressive 88 and their use associated to increased pneumonia incidence compared with molecules with no immunosuppressive activity. 86,89 Also, weak opioids were associated with a reduced risk of hospital-treated pneumonia among Alzheimer's disease patients compared with strong opioids (aHR of 1.54 (1.09-2.17) vs. 2.83 (1.89-4.24)). 90 Moreover, regardless of opioid strength or immunosuppressive features, highest risk was observed during the first two months of use (aHR 2.58, (1.87-3.55)), and disappeared after prolonged use (> 180 days) (0.91 (0.62-1.33)), as for OA patients under chronic management.…”

“…91 Depends on immunosuppressive (IS) and/or weak/strong activities. Absence of IS and/or weak activities are related with reduced pneumonia incidence 86,89,90 Strong Increased influenza-like illness 115 Anti-TNF-α mAb may reduce ACE2 expression. 122 Anti-IL-1β may be beneficial for coronavirus-related complications 126 No evidence for experimental use of mAbs in OA and COVID-19 patients except compassionate use ACE2, angiotensin-converting enzyme 2; AEs, adverse events; COVID-19, coronavirus disease 2019; CVD, cardiovascular disease; IL, interleukin; MERS, Middle East respiratory syndrome; mAbs, monoclonal antibodies; NSAIDs, nonsteroidal antiiflammatory drugs; OA, osteoarthritis; SARS, severe acute respiratory syndrome; TNF, tumor necrosis factor.…”