Neurocognitive performance and depressive mood in people with HIV: The role of prescription opioids use

Background: The issue of potential adverse reactions or toxicities of pharmacotherapies used for chronic diseases in people with HIV (PWH) is still to be clarified. Methods: This study targeted potential effects on neurocognition and mood from prescription opioids, alone or in combination with other classes of drugs, using cross-sectional data from 400 participants in the multicenter CHARTER study. Results: We found that prescription opioid use alone was not associated with neurocognitive performance (β=-1.05, SE=0.80, p=0.18) or depressive mood (β=-0.08, SE=0.19, p=0.65). However, if used in combination with antidepressants, prescription opioid use significantly correlated with reduced neurocognitive performance (β=-2.58, SE=1.17, p=0.03). Also, combinations of prescription opioids and antidepressants with statins (β=-2.87, SE=1.49, p=0.05) or lipid-lowering agents other than statins (β=-2.88, SE=1.39, p=0.04) were associated with lower neurocognitive performance. The interaction of prescription opioid use with the presence of distal sensory polyneuropathy (DSP) was significant (p=0.03). In those without DSP, prescription opioid use was associated with better neurocognitive performance (β=4.25, SE=2.13, p=0.04); by contrast, in those with DSP, the direction of the effect was reversed. No modifying effect on neurocognition was obtained considering distal neuropathic pain, lifetime substance disorder, lifetime major depression diagnosis, or detectable viral load. Conclusion: These findings underscore the importance of neurocognition impact from drug combinations and careful consideration of opioid prescriptions in combination with other medications in the management of PWH.