scholarly journals Opioids in the Management of HIV-Related Pain

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES157-ES168 ◽  
Author(s):  
Daniel Krashin
Keyword(s):  
Chronic Pain ◽  
Human Immunodeficiency Virus ◽  
Opioid Dependence ◽  
Scientific Literature ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Hiv Patients ◽  
Comprehensive Review ◽  
Opioid Treatment ◽  
Immunodeficiency Virus

Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse. Pain management must take these factors into account and use all available modalities, including nonopioid pain relievers, adjuvant medications, and psychosocial therapies in addition to opioid analgesics. Here we review recent recommendations regarding acute and chronic opioid treatment of pain and the treatment of opioid dependence in HIV-infected patients, and provide suggestions regarding aberrant behavior in pain treatment. Objectives: The objective of this comprehensive review is to assess and summarize the complicating factors involved in treating HIV patients’ pain with opioid analgesics. Study Design: This is a narrative review without a systematic quality assessment of the literature discussion. Methods: A comprehensive review of the literature relating to pain and pain treatment in HIV patients. The literature was collected from electronic databases, textbooks, and other sources. The scientific literature reviewed includes randomized trials, observational studies, systematic reviews, guidelines, and government reports. Results: This patient population is heterogeneous and diverse in their medical issues and comorbidities, but a systematic, stepwise approach to assessing and managing pain in HIV patients is described. Chronic opioid treatment has proven to be problematic and considerations and alternatives to this treatment are described. Management of pain in patients with opioid addiction, a frequent comorbidity of HIV infection, requires special awareness and different prescribing practices. Screening and identifying patients who are at special risk for developing medical or behavior complications of pain treatment is essential, and approaches to this, and common forms of aberrant behavior, are described. Limitations: The scientific literature on opioid treatment in this population is limited. The population of HIV patients is heterogeneous and differs in significant ways based on ethnicity, national origin, and mode of transmission, making it difficult to generalize about pain treatment in such a diverse group. Conclusions: Pain management in HIV patients must take these factors into account and use all available modalities for treatment, including nonopioid analgesics, adjuvant medications, and psychosocial therapies. Opioid analgesics should be prescribed with caution in accordance with current guidelines and after careful risk assessment. Key words: HIV, Human Immunodeficiency Virus, acute pain, chronic pain, psychiatric comorbidity, opioid dependence, opioids, chronic opioid therapy, substance abuse.

Unrecognised Human Immunodeficiency Virus Patients in an Emergency Department in Hong Kong: A Report of Four Cases

2005 ◽  
Vol 12 (3) ◽  
pp. 168-177
Author(s):  
KL Mok ◽  
PG Kan
Keyword(s):  
Emergency Department ◽  
Human Immunodeficiency Virus ◽  
Hong Kong ◽  
Hiv Infection ◽  
Opportunistic Infections ◽  
Hiv Patients ◽  
Accident And Emergency ◽  
Immunodeficiency Virus ◽  
High Index Of Suspicion ◽  
Immunodeficiency Syndrome

Human immunodeficiency virus (HIV) causes breakdown of the immune system and predisposes patients to various opportunistic infections and neoplasms. However, many patients may not be aware of the HIV infection before the development of their first HIV related complications. We reported four unrecognised HIV patients presenting to our accident and emergency department with common complications of HIV infection and the acquired immunodeficiency syndrome (AIDS). Although not as common as in America, emergency physicians in Hong Kong still have to take care of patients with unknown HIV status. The common presentations of HIV patients will be discussed. A high index of suspicion and knowledge of common HIV/AIDS complications are required for managing these patients.

Alteration of tumor necrosis factor–α T-cell homeostasis following potent antiretroviral therapy: contribution to the development of human immunodeficiency virus–associated lipodystrophy syndrome

Blood ◽  
2000 ◽  
Vol 95 (10) ◽  
pp. 3191-3198 ◽  
Author(s):  
Eric Ledru ◽  
Névéna Christeff ◽  
Olivier Patey ◽  
Pierre de Truchis ◽  
Jean-Claude Melchior ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
T Cells ◽  
T Cell ◽  
Antiretroviral Therapy ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Interleukin 2 ◽  
Hiv Patients ◽  
Immunodeficiency Virus ◽  
Necrosis Factor

Abstract Highly-active antiretroviral therapy (HAART) has lead to a dramatic decrease in the morbidity of patients infected with the human immunodeficiency virus (HIV). However, metabolic side effects, including lipodystrophy-associated (LD-associated) dyslipidemia, have been reported in patients treated with antiretroviral therapy. This study was designed to determine whether successful HAART was responsible for a dysregulation in the homeostasis of tumor necrosis factor- (TNF-), a cytokine involved in lipid metabolism. Cytokine production was assessed at the single cell level by flow cytometry after a short-term stimulation of peripheral blood T cells from HIV-infected (HIV+) patients who were followed during 18 months of HAART. A dramatic polarization to TNF- synthesis of both CD4 and CD8 T cells was observed in all patients. Because it was previously shown that TNF- synthesis by T cells was highly controlled by apoptosis, concomitant synthesis of TNF- and priming for apoptosis were also analyzed. The accumulation of T cells primed for TNF- synthesis is related to their escape from activation-induced apoptosis, partly due to the cosynthesis of interleukin-2 (IL-2) and TNF-. Interestingly, we observed that LD is associated with a more dramatic TNF- dysregulation, and positive correlations were found between the absolute number of TNF- CD8 T-cell precursors and lipid parameters usually altered in LD including cholesterol, triglycerides, and the atherogenic ratio apolipoprotein B (apoB)/apoA1. Observations from the study indicate that HAART dysregulates homeostasis of TNF- synthesis and suggest that this proinflammatory response induced by efficient antiretroviral therapy is a risk factor of LD development in HIV+ patients.

HIV-1-Associated Neuropathies

CNS Spectrums ◽  
2000 ◽  
Vol 5 (5) ◽  
pp. 66-72 ◽  
Author(s):  
Ashok Verma ◽  
Walter G. Bradley
Keyword(s):  
Chronic Pain ◽  
Human Immunodeficiency Virus ◽  
Peripheral Neuropathy ◽  
Patient Population ◽  
Peripheral Neuropathies ◽  
Toxic Neuropathy ◽  
Immunodeficiency Virus ◽  
Hiv 1 ◽  
Sensory Polyneuropathy

AbstractPeripheral neuropathy associated with human immunodeficiency virus type 1 (HIV-1) infection is a major cause of morbidity in this patient population. Due to the associated chronic pain, its management has come within the purview of neuropsychiatrists. This paper will focus on the primary pathogenic aspects of HIV-1–associated peripheral neuropathies. The specific syndromes of greatest concern are distal sensory polyneuropathy, toxic neuropathy, inflammatory demyelinating polyradiculoneuropathy, and cytomegalovirus-related progressive polyradiculoneuropathy. The treatments available for these conditions and their efficacy are discussed.

Opioid dependence and addiction during opioid treatment of chronic pain

Pain ◽  
2007 ◽  
Vol 129 (3) ◽  
pp. 235-255 ◽  
Author(s):  
Jane C. Ballantyne ◽  
Steven K. LaForge
Keyword(s):  
Chronic Pain ◽  
Opioid Dependence ◽  
Opioid Treatment

scholarly journals Clinical Pharmacokinetics of Nelfinavir and Its Metabolite M8 in Human Immunodeficiency Virus (HIV)-Positive and HIV-Hepatitis C Virus-Coinfected Subjects

2005 ◽  
Vol 49 (2) ◽  
pp. 643-649 ◽  
Author(s):  
Mario Regazzi ◽  
Renato Maserati ◽  
Paola Villani ◽  
Maria Cusato ◽  
Patrizia Zucchi ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hiv Positive ◽  
Therapeutic Drug ◽  
Hiv Patients ◽  
Standard Dosage ◽  
Clinical Pharmacokinetics ◽  
Immunodeficiency Virus ◽  
The Mean

ABSTRACT In order to evaluate the potential risk of nelfinavir (NFV) accumulation in human immunodeficiency virus (HIV)-hepatitis C virus (HCV)-coinfected patients with liver disease, we investigated the concentrations of NFV and M8, the active metabolite of NFV, in plasma HIV-positive (HIV+) patients coinfected with HCV. A total of 119 HIV+ subjects were included in our study: 67 HIV+ patients, 32 HIV+ and HCV-positive (HCV+) patients without cirrhosis, and 20 HIV+ and HCV+ patients with cirrhosis. Most of the enrolled patients (chronically treated) were taking NFV at the standard dosage of 1,250 mg twice a day. To assay plasma NFV and M8 concentrations, patients underwent serial plasma samplings during the dosing interval at steady state. Plasma NFV and M8 concentrations were measured simultaneously by a high-performance liquid chromatography method with UV detection. The HIV+ and HCV+ patients with and without cirrhosis had significantly lower NFV oral clearances than the HIV+ and HCV-negative individuals (28 and 58% lower, respectively; P < 0.05), which translated into higher areas under the concentration-time curves for cirrhotic and noncirrhotic patients. The NFV absorption rate was significantly lower in cirrhotic patients, resulting in a longer time to the maximum concentration in serum. The mean ratios of the M8 concentration/NFV concentration were significantly lower (P < 0.05) in HIV+ and HCV+ subjects with cirrhosis (0.06 ± 0.074) than in the subjects in the other two groups. The mean ratios for M8 and NFV were not statistically different between HIV+ and HCV-negative patients (0.16 ± 0.13) and HIV+ and HCV+ patients without cirrhosis (0.24 ± 0.17), but the interpatient variability was high. Our results indicate that the pharmacokinetics of NFV and M8 are altered in HIV+ and HCV+ patients, especially those with liver cirrhosis. Therefore, there may be a role for therapeutic drug monitoring in individualizing the NFV dosage in HIV-HCV-coinfected patients.

Comment on Ballantyne and LaForge, Opioid dependence and addiction during opioid treatment of chronic pain. Pain 2007;129:235–55

Pain ◽  
2007 ◽  
Vol 132 (1) ◽  
pp. 218-219
Author(s):  
Robert N. Jamison ◽  
Edgar L. Ross ◽  
Ajay D. Wasan ◽  
Edward Michna
Keyword(s):  
Chronic Pain ◽  
Opioid Dependence ◽  
Opioid Treatment
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