Increased Risk of Fragility Fractures among HIV Infected Compared to Uninfected Male Veterans

Womack, Julie A.; Goulet, Joseph L.; Gibert, Cynthia L.; Brandt, Cynthia; Chang, Chung Chou H.; Gulanski, Barbara; Fraenkel, Liana; Mattocks, Kristin M.; Rimland, David; Rodriguez‐Barradas, Maria C.; Tate, Janet P.; Yin, Michael T.; Justice, Amy C.

doi:10.1371/journal.pone.0017217

Cited by 240 publications

(224 citation statements)

References 57 publications

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“…For example, data indicate that compared to other analgesics, opioids are associated with increased cardiovascular events and fractures 19,21 both of which occur more commonly among HIV-infected patients. 26,47 Similarly, some evidence suggests that opioids may adversely impact the immune system. 18 Our univariate analysis demonstrated a trend towards lower CD4 cell counts among patients on opioids, a finding that may be confounded by indication and did not persist in multivariable analyses.…”

Section: Discussionmentioning

confidence: 99%

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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BACKGROUND: Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status. OBJECTIVES: To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids. DESIGN: Cross-sectional analysis of the Veterans Aging Cohort Study. PARTICIPANTS: HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls. MAIN MEASURES: Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥120 mg of morphine equivalents; long-term opioids was defined as ≥90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes. KEY RESULTS: Among the HIV+ (n = 23,651) and uninfected (n=55,097) patients, 31 % of HIV+ and 28 % of uninfected (p<0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p=0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p<0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p<0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p< 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01). CONCLUSIONS:Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.

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Section: Discussionmentioning

confidence: 99%

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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“…The resulting aging of the HIV-population and a variety of effects related to specific antiretroviral drug exposure have been associated to the skeletal disorders [3,7,8]. A number of the traditional osteoporosis risk factors may be more prevalent in HIV-infected patients: vitamin D deficiency [9], low body weight [7,10], lifestyle risk factors (including alcohol consumption [7], smoking, corticosteroid use [11] and drug addiction [12]), as well as the HIV infection per se (due to immunodeficiency). In addition, the chronic pro-inflammatory status and the direct action of HIV proteins may also play a role in decreasing bone mineral density (BMD) [4].…”

Section: Introductionmentioning

confidence: 99%

Associated Factors and Liver Disease Severity for Decreased Bone Mineral Density in HIV Mono- and HIV/HCV Co-infected Patients

Vecchi¹,

Soresi²,

Giannitrapani³

et al. 2015

J AIDS Clin Res

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“…Thus, Pneumocystis may act as a profound comorbidity factor that may also enhance secondary systemic disease manifestations associated with chronic pulmonary diseases and HIV infection such as osteoporosis or bone marrow dysfunctions (22)(23)(24)(25)(26)(27)(28). Immunity to Pneumocystis requires the presence of functional CD4 ϩ T cells to stimulate antigen-specific immune globulin production by B cells and macrophage-mediated phagocytosis (4,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38).…”

mentioning

confidence: 99%

B Cells Modulate Systemic Responses to Pneumocystis murina Lung Infection and Protect On-Demand Hematopoiesis via T Cell-Independent Innate Mechanisms when Type I Interferon Signaling Is Absent

et al. 2015

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HIV infection results in a complex immunodeficiency due to loss of CD4؉ T cells, impaired type I interferon (IFN) responses, and B cell dysfunctions causing susceptibility to opportunistic infections such as Pneumocystis murina pneumonia and unexplained comorbidities, including bone marrow dysfunctions. Type I IFNs and B cells critically contribute to immunity to Pneumocystis lung infection. We recently also identified B cells as supporters of on-demand hematopoiesis following Pneumocystis infection that would otherwise be hampered due to systemic immune effects initiated in the context of a defective type I IFN system. While studying the role of type I IFNs in immunity to Pneumocystis infection, we discovered that mice lacking both lymphocytes and type I IFN receptor (IFrag Pneumocystis is a ubiquitous extracellular pulmonary fungal pathogen with strict species specificity. It is likely contracted via airborne transmission from often transiently infected individuals and commonly causes few or unspecific symptoms in otherwise healthy individuals leading to immunity (reviewed in references 1 and 2). However, Pneumocystis can cause severe and progressive interstitial pneumonia in patients with impaired acquired immunity with mortality rates up to 60% (3). While the total number of functional CD4 ϩ T cells critically determines increased susceptibility to Pneumocystis lung infection, patients with B cell defects are also at risk. In this regard, Pneumocystis pneumonia (PCP) is an AIDSdefining condition during HIV disease progression and commonly occurs when CD4 ϩ T cell counts drop below 200 cells/l (4). Furthermore, immune suppressive and cell ablative therapy following solid-organ transplantation, autoimmunity, or cancer treatment reduce CD4 ϩ T cell and/or B cell numbers and impair functions in non-HIV patients (reviewed in references 5 and 6). Drug regimens that predispose to severe Pneumocystis infections include high-dose glucocorticoid and B cell ablative treatments with rituximab (7-11). In addition, low-grade Pneumocystis infection is found in patients with potentially subtle immune suppressions such as young infants, HIV-positive patients receiving HAART (highly active antiretroviral therapy), or patients receiving low-dose and inhaled glucocorticoids (12)(13)(14). This can promote bronchial hyperreactivity, is associated with sudden infant death syndrome (SIDS) and exacerbation of chronic obstructive lung diseases (15)(16)(17)(18)(19).Pneumocystis colonization also intensifies signs of systemic inflammation (20, 21). Thus, Pneumocystis may act as a profound comorbidity factor that may also enhance secondary systemic disease manifestations associated with chronic pulmonary diseases and HIV infection such as osteoporosis or bone marrow dysfunctions (22-28). Immunity to Pneumocystis requires the presence of functional CD4 ϩ T cells to stimulate antigen-specific immune globulin production by B cells and macrophage-mediated phagocytosis (4,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). In addition, early innate t...

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Increased Risk of Fragility Fractures among HIV Infected Compared to Uninfected Male Veterans

Cited by 240 publications

References 57 publications

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Associated Factors and Liver Disease Severity for Decreased Bone Mineral Density in HIV Mono- and HIV/HCV Co-infected Patients

B Cells Modulate Systemic Responses to Pneumocystis murina Lung Infection and Protect On-Demand Hematopoiesis via T Cell-Independent Innate Mechanisms when Type I Interferon Signaling Is Absent

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