HIV, Alcohol Use Disorders and Pain: New Findings to Address the Problem

Abstract

Background: Alcohol use and pain are frequent problems among people living with HIV/AIDS (PLWHA). Therefore, increasing the understanding of the interaction between these medical conditions is critical to improve health care and quality of life forthis population. While gender differencesin alcohol use andmood disorders are widely recognized, little is known about gender disparities in prescription of painkillers and correlates. Equally important is the lack of information regarding the role of neurotrophic factors although animal models have demonstrated BDNF pronociceptive effects. Methods: Using a clinic-based sample of people living with H.I.V/AIDS (PLWHA), we investigated the prevalence and correlates associations of recent pain killer use. We also assessed the effects of gender, mood and Brain Derived Neurotrophic Factor levels (BDNF). Participants were 400 people living with HIV (PLWHA) who participated in the PADS cohort study. Results: Approximately, a quarter (24%) of the sample reported regularly taking painkillers, and a correlation was evident with both CD4s and viral loads. Painkiller users were typically over 40. Ifthey weremales, painkiller users weremore likely to be Caucasian; however, painkiller female users were more likely to be minorities. Factors related to painkiller use also differed between men and women. Analyses demonstrated that the weekly consumption of alcohol was significantly higher in the painkiller group compared to controls (19.4 ± 3.9 vs. 15.9 ± 1.34 drinks/week; p=0.03). Compared to non-hazardous alcohol users (non-HAU), female-hazardous alcohol users (HAU’s) were more likely to be using prescription opioids (Odds Ratio: 4.6 95% Confidence Interval: 1-22.9, p=0.04). No such trend was observed among males. Noteworthy, higher scores of both depression and stress were observed among painkiller users. Gender differences were notable; women using painkillers exhibited significantly higher scores on both depression (19.6 ± 12.4 vs. 13.6 ± 11.7 total score; p=0.01), and stress (19.4 ± 8.3 vs. 14.9 ± 8.1 total score; p=0.004) while men did not. In our analyses, BDNF levels were significantly higher among subjects taking painkillers than those not taking them. In Longitudinal analyses, confirmed that hazardous alcohol use, BDNF levels, and gender were associated with greater odds of using painkillers at 6 months. Conclusion: These findings highlight the importance of designing gender-sensitive surveillance, prevention, and treatment. Our findings extend earlier research by revealing that BDNF may account for important aspects of pain and alcohol abuse. The apparent implication of these findings is that interventions targeting BDNF may have considerable therapeutic potential in this population