TOPLINE

Among people living with HIV (PWH), the use of prescription opioids alone was not linked to reduced neurocognitive performance or depressive mood, whereas the use of prescription opioids in combination with other medications — particularly antidepressants — was associated with poorer cognitive outcomes.

METHODOLOGY

• This cross-sectional analysis of 400 PWH (mean age, 56.2 years; 76.3% men) from the CHARTER study examined whether prescription opioids, alone or in combination with other medications, affected neurocognition and mood.
• Neuromedical assessments included neurologic and medical examinations as well as clinical laboratory tests. Distal sensory polyneuropathy (DSP) was assessed by distal reduction or bilateral loss of ankle reflexes or sensations in the legs and feet.
• The current use of prescription opioids (codeine, dihydrocodeine, fentanyl, hydrocodone, hydromorphone, meperidine, or oxycodone) was recorded; concomitant medication classes assessed included statins, antidepressants, and lipid-lowering agents other than statins.
• The primary outcome was global neurocognitive performance, measured across seven domains (verbal fluency, working memory, speed of information processing, learning, delayed recall, executive function, and complex motor function).
• The secondary outcome was depressive mood, assessed using the Beck Depression Inventory-II (scores > 13 indicated at least mild depression).

TAKEAWAY

• Overall, 33% of participants were taking opioids. After adjustment, the use of prescription opioids alone was not significantly associated with neurocognitive performance or depressive mood.
• The combined use of prescription opioids and antidepressants was significantly associated with reduced neurocognitive performance (beta-coefficient = -2.58; P = .03); the interaction between opioid and antidepressant was significant (P = .027).
• The use of opioids, antidepressants, and statins was tied to lower neurocognitive performance, with borderline statistical significance (P = .05), whereas the use of opioids, antidepressants, and lipid-lowering agents other than statins was tied to significantly lower performance (P = .04).
• The presence of DSP significantly modified opioid effects (P = .03), such that opioid use was associated with better neurocognitive performance in participants without neuropathy (P = .04) but with lower neurocognitive performance, albeit not significantly, in those with neuropathy.

IN PRACTICE

“While prescription opioid use alone does not appear to significantly impact neurocognitive performance or depressive mood in PWH, it remains important to monitor opioid use,” the authors wrote.

“The presence of DSP modifies the relationship between prescription opioid use and cognitive performance, highlighting the need for personalized treatment strategies,” they added.

SOURCE

The study was led by Enrico Ripamonti, PhD, University of Milan-Bicocca, Milan, Italy. It was published online on May 26, 2026, in JAIDS Journal of Acquired Immune Deficiency Syndromes.

LIMITATIONS

Data on the history of prescription opioid use, treatment duration, and dosing were unavailable. The reliance on self-reported medication use may have introduced misclassification or recall bias. The long-term patterns or the effects of polypharmacy could not be assessed.

DISCLOSURES

The study was funded by the National Institute of Mental Health, and the authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.