601. Prescription Drug Misuse in an HIV-Infected U.S. Military Cohort
Session: Poster Abstract Session: HIV: Management and Clinical Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDCRP HIV 09_27_18 FINAL (002).pdf (478.2 kB)
  • Background: Prescription drug misuse (PDM) has markedly increased over the last decade and is a significant contributor to the national opioid epidemic. HIV+ individuals are particularly vulnerable to PDM as they experience high levels of chronic pain, anxiety and depression. We examined the prevalence of PDM and associated risk factors among HIV-infected subjects in our cohort.

    Methods: The U.S. Military HIV Natural History Study (NHS) is comprised of HIV+ active duty, retired military personnel and dependents. Since 2014, participants have completed a computerized behavioral survey regarding patterns of drug use and sexual behavior. We specifically queried topics including use of narcotics, benzodiazepines or stimulants without a prescription or use of medications not as prescribed. Logistic regression was used to compare those reporting and not reporting a lifetime history of PDM. Analyses used anonymous data.

    Results: Among 1,558 respondents, 292 (18.7%) reported a history of PDM. The median age of individuals reporting history of PDM was 45y (Interquartile Range [IQR] 31-53) compared with individuals without PDM (41y; IQR 29-35; p=0.049); the groups did not differ by race, CD4 count or viral load. The prevalence of lifetime PDM was highest among dependent individuals (31.8%), compared with retired (20.6%) or active-duty personnel (15.9%; p=0.003 for comparison). After adjusting for age and duty status, military officers were significantly less likely to report PDM than enlisted personnel (OR 0.51; IQR 0.31-0.85). Those with a history of PDM were more likely to consume ≥ 3 alcoholic drinks/day (OR 1.9; IQR 1.4-2.5). In a sub-analysis of active-duty personnel only (median age 30y), individuals reporting a history of PDM had fewer years since HIV diagnosis (median 2.9y vs 3.9y, p=0.019).

    Conclusion: We found prevalent PDM among HIV-infected military personnel and beneficiaries, and PDM was associated with at-risk drinking. This is the first estimate of PDM among HIV+ active-duty personnel, and longitudinal studies in similar cohorts will be useful in further characterizing the epidemiology of PDM. The higher prevalence among recently diagnosed active-duty personnel may suggest an increasing scope of PDM in this group, and interventions to decrease PDM are urgently needed.

    Robert Deiss, MD1, Morgan Byrne, MPH2, Derek Larson, DO3, Anuradha Ganesan, MD, MPH4, Adi Noiman, PhD5, Eric Garges, MD, MPH5, Kelli Randell, MD6, Jason Okulicz, MD7, Karl Kronmann, MD, MPH8, Christina Schofield, MD FACP, FIDSA9, Grace Macalino, PhD10, Ryan Maves, MD, FCCP, FIDSA11 and Brian Agan, MD12, (1)Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, MD, (2)Infectious Disease Clinical Research Program, Uniformed Services Unifersity of Health Sciences, Rockville, MD, (3)Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, (4)Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (5)Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, (6)United States Navy, San Diego, CA, (7)Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, TX, (8)Naval Medical Center Portsmouth, Portsmouth, VA, (9)Madigan Army Medical Center, Tacoma, WA, (10)Marimac Insight, Simpsonville, MD, (11)Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, (12)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD

    Disclosures:

    R. Deiss, None

    M. Byrne, None

    D. Larson, None

    A. Ganesan, None

    A. Noiman, None

    E. Garges, None

    K. Randell, None

    J. Okulicz, None

    K. Kronmann, None

    C. Schofield, None

    G. Macalino, None

    R. Maves, None

    B. Agan, None

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