TOPLINE:

In patients with HIV infection, the use of opioids alone was not associated with reduced cognition or depressive mood, whereas the combined use of opioids, antidepressants, and statins or lipid-lowering drugs other than statins was associated with lower neurocognitive performance.

METHODOLOGY:

• Researchers analyzed data from 400 patients with HIV infection (mean age, 56.2 years; 76.3% male) who were reevaluated about 12 years after their baseline assessment in the CHARTER study to assess the association of opioid use with neurocognitive function and depressive mood.
• All patients were classified on the basis of the likely contribution of comorbidities to neurocognitive impairment in HIV infection — incidental (n = 228), contributing (n = 128), or confounding (n = 44).
• The primary outcome was global neurocognitive performance, measured using the Global T score — the mean of individual T scores across seven domains (verbal fluency, working memory, processing speed, learning, delayed recall, executive function, and complex motor). Higher scores indicated better cognition.
• The secondary outcome was the presence of depressive mood, assessed using the Beck Depression Inventory-II (BDI-II); scores > 13 indicated at least a mild depressive mood.
• Exposure to opioids was defined as the current use of one or more prescription opioids — codeine, dihydrocodeine, fentanyl, hydrocodone, hydromorphone, meperidine, or oxycodone — at the CHARTER visit.

TAKEAWAY:

• The use of opioids alone was not significantly associated with the Global T score (regression coefficient [beta], -1.05; P = .18) in multivariate analysis. However, the combined use of opioids and antidepressants was significantly associated with a 2.58-point lower Global T score (P = .03).
• The use of the combination of opioids, antidepressants, and statins was associated with lower Global T scores (beta, -2.87; P = .05); a similar effect was observed for the use of the combination of opioids, antidepressants, and lipid-lowering agents other than statins (beta, -2.88; P = .04).
• In the incidental subgroup, opioid use was associated with better cognition in patients without distal sensory polyneuropathy (DSP; beta = 4.25; P = .04) but showed a negative, nonsignificant association in patients with DSP.
• No significant association was found between opioid use and BDI-II scores.

IN PRACTICE:

“The presence of DSP modifies the relationship between opioid use and cognitive performance, highlighting the need for personalized treatment strategies,” the authors of the study wrote.

SOURCE:

The study was led by Enrico Ripamonti, PhD, University of Milan-Bicocca, Milan, Italy. It was published online on February 2, 2026, in the Journal of Acquired Immune Deficiency Syndromes.

LIMITATIONS:

The study was limited by its cross-sectional design; reliance on self-reported medication use; lack of information on opioid use history, duration, and detailed dosing; and a predominantly male sample with high AIDS prevalence, which may have limited generalizability to other patients with HIV infection.

DISCLOSURES:

The study was funded by the National Institute of Mental Health. The authors declared 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.