Opioids Prescribed Twice as Often for Women with HIV Than Men

A retrospective examination of the medical records of over 1000 people living with HIV/AIDS has revealed inequalities in the prescribing of mental health medications. The differences in medical relief run along socioeconomic and ethnic lines.

“Our results highlight socioeconomic and ethnic differences in prescription of mental health medications. The higher proportion of opiate prescriptions among women needs confirmation and should be a priority for intervention,” wrote a cadre of researchers from various American institutions in the poster presented today at the 2018 IDWeek Annual Meeting in San Francisco, CA.

The study also revealed the greater risk of baseline neurocognitive impairment and slow gait in men. Whether this reflects differences in drug toxicity, drug interactions, or more persistent mental health symptoms in men remain speculative.

The findings are disturbing. HIV/AIDS is emotionally and physiologically stressful. The viral infection and other opportunistic infections can sap energy and optimism, leaving people vulnerable to depression and other mental health challenges.¹ Physiologic changes to the nervous system can cause behavioral changes. These and other mental health challenges may be lessened by medications.

The investigators examined the records of people living with HIV who had been part of the AIDS Clinical Trials Group (ACTG) A5322 (HAILO) study of the ACTG Clinical Trials Group. The HAILO study was undertaken to clarify the characteristics of older individuals living with HIV/AIDS. The information collected for 4 consecutive years from each individual included any medications taken for the relief of mental health disorders or pain. The associations between the use of mental health medications and a variety of factors were assessed, including the type (or lack) of insurance, race, ethnicity, gait (as an indicator of neurological impairment), and diminished neurocognition.

The 1035 participants had a median age of 51 years. The majority (81%) were men, 30% were black, and 20% were Hispanic. Drugs had been prescribed for mental health relief for about the same number of men and women (34% and 38%, respectively; P = .19). The types of drugs prescribed were similar between men and women, with the exception of opioids, which were prescribed for women over twice as often as for men (12% vs 5%; P <.001).

Multivariable analysis was used to try to tease out statistically significant relationships between drug use and various factors. Access to drugs was more likely for those enrolled in Medicare (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.50-4.16; P <.001) and Medicaid (OR 1.85, 95% CI 1.23-2.78; P = .003) compared to those with no or unknown insurance. Additionally, access for Hispanics was less than for whites (OR 0.48, 95% CI 0.33-0.69; P < .001).

Other factors associated with better access to medications included neurological impairment at the beginning of the study (OR 1.80, 95% CI 1.34-2.40; P <.001), which was more prevalent in men compared to women (Hazard ratio 1.74, 95% CI 1.22-2.48 vs 0.76, 95% CI 0.38-1.52; P for interaction = 0.038). Neurocognitive impairment was not implicated as an influential factor for men (OR 1.70, 95% CI 1.09-2.66) or for women (OR 0.96, 95% CI 0.43-2.18); the difference between men and women was not statistically appreciable in the multivariable analysis (P for interaction = .227).

The poster presenter was Swati Mathus, MD, Department of Internal Medicine, University of Colorado School of Medicine in Denver.

REFERENCE:

1. National Institute of Mental Health. HIV/AIDS and Mental Health. nimh.nih.gov/health/topics/hiv-aids/index.shtml. Updated November 2016. Accessed October 3, 2018.

DISCLOSURES

Swati Mathur, MD: None

PRESENTATIONS

Poster Session: HIV Management and Clinical Outcomes

Swati Mathu, MD, University of Colorado

Poster 583. Demographic Factors and Clinical Outcomes Associated with Mental Health Medication Use in People Living with HIV

Brian Hoyle, PhD, is a medical and science writer and editor from Halifax, Nova Scotia, Canada. He has been a full-time freelance writer/editor for over 15 years. Prior to that, he was a research microbiologist and lab manager of a provincial government water testing lab. He can be reached at hoyle@square-rainbow.com.