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Functional Impairment and Cognitive Symptoms Among People with HIV Infection on Chronic Opioid Therapy for Pain: The Impact of Gabapentin and Other Sedating Medications

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Abstract

Gabapentin is associated with dizziness, falls, and somnolence yet commonly prescribed to people with HIV (PWH) treated with chronic opioid therapy (COT). Physical function and cognition are understudied when prescribed together. Among PWH on COT, we evaluated whether co-prescribed gabapentin is associated with (a) functional impairment; (b) trouble thinking clearly; and (c) difficulty controlling drowsiness using logistic regression models adjusted for prescribed opioid dose, other (non-gabapentin) sedating medication, substance use disorder, and mental/physical health indicators in a cross-sectional study. Among 166 participants, 40% were prescribed gabapentin, 41% reported functional impairment, 41% trouble thinking clearly, and 38% difficulty controlling drowsiness. Gabapentin co-prescribed with COT was significantly associated with trouble thinking clearly but not with functional impairment or difficulty controlling drowsiness. Clinicians should be cognizant of potential problems with thinking clearly when co-prescribing gabapentin and opioid medication.

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Data Availability

A de-identified dataset upon request.

Code Availability

No.

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Funding

This study was supported by the National Institute on Drug Abuse (NIDA) (R01DA037768), the Boston/Providence Center for AIDS Research (CFAR) (P30AI042853), and the Emory CFAR (P30AI050409). Dr. Kimmel reports additional support from NIDA (K23DA054363) and the Clinical Addiction Research and Education Unit (R25DA013582). The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Theresa W. Kim, Jeffrey H. Samet, Simeon D. Kimmel, Marlene C. Lira & Alexander Y. Walley

  2. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA

    Jeffrey H. Samet

  3. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Sara Lodi

  4. Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Simeon D. Kimmel

  5. Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA

    Leah S. Forman

  6. Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Jane M. Liebschutz

  7. Department of Health Services, University of Washington, Seattle, WA, USA

    Emily C. Williams

  8. Veterans Health Administration Health Services Research and Development, Center of Innovation for Veteran-Centered Value-Drive Care, Seattle, WA, USA

    Emily C. Williams

Authors
  1. Theresa W. Kim
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  2. Jeffrey H. Samet
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  3. Sara Lodi
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  4. Simeon D. Kimmel
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  5. Leah S. Forman
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  6. Marlene C. Lira
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  7. Jane M. Liebschutz
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  8. Emily C. Williams
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  9. Alexander Y. Walley
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Contributions

Study design (TWK, JHS, SL, SDK, JML, ECW, AYW), Data collection and management (SL, LSF, MCA), Data analysis (SL, LSF), Drafted manuscript (TWK), All contributed to interpretation of results, critical revision, manuscript editing, and approval of the manuscript.

Corresponding author

Correspondence to Theresa W. Kim.

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The authors declare that they have conflict of interest.

Ethical Approval

Study procedures were approved by institutional review boards at Boston University Medical Campus, Emory University, and the Grady Memorial Hospital.

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Yes.

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Kim, T.W., Samet, J.H., Lodi, S. et al. Functional Impairment and Cognitive Symptoms Among People with HIV Infection on Chronic Opioid Therapy for Pain: The Impact of Gabapentin and Other Sedating Medications. AIDS Behav 26, 3889–3896 (2022). https://doi.org/10.1007/s10461-022-03716-3

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