Title : Patterns and Predictors of Opioid Use Disorder in Youths with HIV A 10 year Trend
Abstract:
Introduction:
Over the past decade, there has been a steady uptick in overdose deaths in the United States, including during this ongoing covid-19 pandemic. While the majority of drug overdoses occur in adults, about 9% (4,235) of youths between the ages of 13 and 24 years died from opioid-related overdose in 2015. Also, the Center for Disease Control and Prevention in 2017, reports that youth aged 13 to 24 made up 21% (8,164) of the 38,739 new Human Immunodeficiency Virus (HIV) diagnoses in the United States. It is worth mentioning that youths with HIV are the least likely of any age group to be linked to care in a timely manner and have the least suppressed viral load. The youths may engage in high-risk behaviors such as needle sharing for drug use, sex without a condom and are less likely to utilize pre- or post-HIV exposure prophylaxis when under the influence of drugs including opioids. In addition, adherence to medications is especially difficult for youths. Ultimately, Opioid Use Disorder (OUD) develop among this population of youths with HIV. This is a substantial clinical/public health concern given the resultant HIV comorbidity in addition to the elevated risk for fatal and non-fatal opioid overdose.
Method:
We analyzed a cross-sectional study design of the National Inpatient Sample (NIS) dataset, a component of the Healthcare Cost and Utilization Project (HCUP) over a 10-year period (2008 – 2017). The variables of interest were identified using the ICD-9 & 10-CM codes. We selected the inpatient stays for all patients aged 13 - 24 years admitted for HIV-related medical condition. A diagnosis of OUD was the primary outcome of interest. Secondary outcomes were the patterns and predictors of OUD including sex, race, type of insurance, level of income, degree of urbanization, region of the country (USA) lived and a history of mental health diagnosis. Multivariable logistic regression was performed using SAS v9.4 (SAS Institute, Cary, NC) for the statistical analysis. Statistical significance was set at 95% confidence interval and p-value of 0.05.
Result:
Of the 5,632 youths with HIV, 3.38% had a comorbid OUD diagnoses. After adjusting for sex, race, mental health diagnosis, having HIV was associated with higher odds of OUD (p<0.05) among youths aged 13-24 years. Having a mental health disorder [O.R 2.26 (1.35-3.78)] was associated with increased odds of OUD in this age group.
Conclusion:
OUD was significantly associated with youths living with HIV. This result highlights the importance of identifying these high-risk youths and initiating early interventions to limit risky misuse of prescription drugs particularly opioids. Hence, it is critical that providers and public health experts recognize and incorporate the unique needs of youths living with HIV especially the racial minority youths into traditional treatment and prevention models since comorbid HIV and OUD is associated with limited healthcare resource utilization and poor clinical outcomes.
Aims:
- To determine the patterns and trend of OUD among youths with HIV from the existing public health policy.
- To predict factors that clinicians should keep in mind in the evaluation of OUD among youths with HIV
- To expand the clinical knowledge base that other faculty could use in their teaching and/or research into the prevention and treatment of OUD among youths with HIV.
