Pneumonia Risk Elevated in Patients With, Without HIV

Patients who are prescribed opioids are at a higher risk of developing pneumonia, according to a new examination of healthcare records of patients with and without HIV.

The research draws together a number of recent scientific findings and data points. Opioids are widely prescribed to patients with and without HIV, community-acquired pneumonia (CAP) is a major cause of mortality and morbidity among patients with HIV, and a number of earlier studies have suggested that opioids like codeine and fentanyl can suppress the immune system.

Scientists at Yale University wanted to conduct a large-scale study to see if it would affirm the apparent correlation between opioid use and pneumonia specifically.

The investigators used records from the Veterans Aging Cohort Study, a long-term study of patients who sought care in Veterans Health Administration (VA) facilities between 2000 and 2012. They found 4246 patients who had required hospitalization for community-acquired pneumonia and matched them with a cohort of 21,146 patients of similar ages, sexes, race, and HIV status.

The data showed that patients who had been prescribed medium or high doses of opioids had significantly higher rates of pneumonia, particularly if the prescribed opioid had immunosuppressive qualities. For instance, patients taking a high dose of opioids that did not have immunosuppressive qualities (or in cases where the immunosuppressive status was unknown) had an adjusted odds ratio of acquiring pneumonia of 2.07. For patients taking high doses of immunosuppressive opioids, the adjusted odds ratio was 3.18. Patients with past opioid use also had higher risks of pneumonia, though the size of the increased risk was lower.

"We saw that prescription opioids were independently associated with pneumonia requiring hospitalization," said E. Jennifer Edelman, MD, MHS, an associate professor at Yale School of Medicine, in a press release.

Edelman, the study’s corresponding author, added that the research “lends credence to the hypothesis that opioids have effects on the immune system that are clinically relevant.”

There are a number of ways opioids could be affecting the immune system. Among them, opioids can suppress the tactics a patient’s body uses to fight pneumonia infection, such as coughs, respiration, and mucus secretion, Edelman said.

When the data were stratified based on HIV status, the authors found people living with HIV (PLWH) had consistently higher risk for pneumonia when taking opioids.

“The findings from the present study, however, suggest that HIV infection may make patients more susceptible to the effects of prescribed opioids and are consistent with our findings demonstrating that PLWH have a greater mortality risk at lower opioid doses than uninfected individuals,” Edelman and colleagues wrote.

The authors said physicians should consider the correlation between opioids and pneumonia when making prescribing decisions. They added that further study is needed to find out whether strategies like shorter durations of opioid use, lower doses, or sticking to non-immunosuppressive opioids might lower the pneumonia risk.

“For now, in those settings when prescribed opioids are warranted, care should be implemented to address other risk factors (eg, smoking cessation and vaccination) known to modify CAP risk,” they concluded.

The study, “Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV,” was published in JAMA Internal Medicine.
 

This article was originally published by MD Magazine.




Stay up to date on the latest news in specialty pharmacy by getting Specialty Pharmacy Times in your mailbox or inbox for free!

Click here to sign up for free for the bi-monthly Specialty Pharmacy Times print journal delivered to your address.

Click here to sign up for our email newsletters delivered every Monday, Wednesday, and Friday, in addition to breaking news alerts.

Click here to follow us on Facebook. 

Click here to follow us on Twitter. 

Click here to join our LinkedIn group. 


Most Popular

Related Articles

This weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings, and more. Our Week in Review is a can't miss for the busy pharmacy professional.
Glecaprevir/pibrentasvir (G/P) plus sofosbuvir and ribavirin can potentially treat patients who experienced previous virologic failure following G/P therapy.
Top news of the day from across the health care landscape.
Company Profile >
Industry Guide >
Market News >
Peer Exchange >
Conferences >
Subscribe >
Specialty Times Resources
About Us
Advertise
Careers
Contact Us
Terms & Conditions
Privacy
MJH Associates >
Pharmacy Times
OTCGuide
American Journal of Managed Care
Cure
MD Magazine
ONCLive
Targeted Oncology
Physicians' Education Resource
Pharmacy & Healthcare Communications, LLC
2 Clarke Drive
Suite 100
Cranbury, NJ 08512
P: 609-716-7777
F: 609-716-4747

Copyright Specialty Pharmacy Times 2006-2018
Pharmacy & Healthcare Communications, LLC. All Rights Reserved.
 

$vacMongoViewPlus$