Prescription opioids up pneumonia risk, especially in HIV

  • Edelman EJ & al.
  • JAMA Intern Med
  • 7 Jan 2019

  • curated by Liz Scherer
  • Clinical Essentials
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  • There is a strong, independent association between prescribed opioids and community-acquired pneumonia (CAP) requiring hospitalization, particularly among people living with HIV (PLWH).
  • CAP risk is dose- and formulation-dependent.

Why this matters

  • Consider CAP risk when prescribing opioids for PLWH.
  • Use lower-dose, nonimmunosuppressive opioids whenever possible.
  • Address other CAP risk factors (e.g., smoking cessation, vaccination).

Key results

  • 25,392 participants (10,486, 14,906 uninfected, PLWH, respectively), 98.9% (n=20,917 male).
  • Current prescribed high-dose opioids were associated with greatest CAP risk, including formulations with unknown/no immunosuppressive properties (aOR, 2.07; 95% CI, 1.50-2.86), immunosuppressive properties (aOR, 3.81; 95% CI, 2.44-4.14) vs medium unknown/no immunosuppressive properties (aOR, 1.35; 95% CI, 1.13-1.62), immunosuppressive opioids (aOR, 2.07; 95% CI, 1.50-2.86).
  • Stratified analysis likewise showed CAP risk greatest among PLWH with current prescribed opioids, especially high-dose immunosuppressive agents (OR, 3.26; 95% CI, 2.24-4.73).
  • PLWH taking medium-dose, immunosuppressive opioids had higher CAP risk vs uninfected (ORs 2.23 [95% CI, 1.60-3.40] vs 1.76 [95% CI, 1.20-2.57]).

Study design

  • Nested case-control study evaluating association between prescribed opioids and CAP requiring hospitalization among PLWH vs uninfected persons.
  • Funding: National Institute on Alcohol Abuse and Alcoholism.


  • Unmeasured confounding.
  • Presumed adherence.
  • Inability to account for illicit opioid use.
  • Limited generalizability.

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