Edelman EJ, et al. - In this nested case-control study involving 4,246 patients and 21,146 control participants, researchers studied the link between prescription opioids and community-acquired pneumonia (CAP) by opioid properties and HIV status. According to findings, persons with and without HIV demonstrated a link between prescribed opioids, especially higher-dose and immunosuppressive opioids, and increased CAP risk.

Methods

• From January 1, 2000, through December 31, 2012, researchers collected and analyzed data from patients in the Veterans Aging Cohort Study (VACS), including those living with and without HIV who received care in Veterans Health Administration (VA) medical centers across the United States.
• Patients with CAP necessitating hospitalization were matched 1:5 with control participants by age, sex, race/ethnicity, length of observation, and HIV status.
• From March 15, 2017, through August 8, 2018, data analysis was carried out.
• A composite variable based on timing (none, past, or current); low (< 20 mg), medium (20-50 mg), or high (> 50 mg) median morphine equivalent daily dose; and opioid immunosuppressive properties (yes vs unknown or no), characterized prescribed opioid exposure during the 12 months prior to the index date.
• CAP requiring hospitalization based on VA and Centers for Medicare & Medicaid data was the main outcome and measure.

Results

• The greatest CAP risk was observed in association with current medium doses of opioids with unknown or no immunosuppressive properties and immunosuppressive properties and current high doses of opioids with unknown or no immunosuppressive properties and immunosuppressive properties vs no prescribed opioids or any past prescribed opioid with no immunosuppressive and immunosuppressive properties. This link was particularly evident with current receipt of immunosuppressive opioids.
• Stratified analyses revealed a consistently greater CAP risk among people living with HIV with current prescribed opioids, especially when prescribed immunosuppressive opioids.