Merlin-JessicaDr. Jessica Merlin's paper entitled "Pain, Mood, and Substance Abuse in HIV: Implications for Clinic Visit Utilization, Antiretroviral Therapy Adherence, and Virologic Failure", published in Journal of Acquired Immune Deficiency Syndrome, has been selected as the Department of Medicine's paper of the month for Feburary 2013.

Dr. Jessica Merlin received her MD and MBA degrees from the University of Pennsylvania.  She went on to complete a residency in Internal Medicine and a fellowship in Infectious Diseases at the Hospital of the University of Pennsylvania, and a fellowship in Palliative Medicine at the Mount Sinai School of Medicine in New York.  She is currently an Assistant Professor with joint appointments in the Divisions of Infectious Diseases and Gerontology, Geriatrics, and Palliative Care.  Her clinical work includes directing the 1917 HIV/Palliative Care clinic, which cares for many HIV-infected patients with chronic pain.

Dr. Merlin's research focus is on HIV and chronic pain, especially in patients with psychiatric and substance abuse comorbidities.  In September 2012, she received a K12 career development award to adapt, pilot, and begin to validate a Brief Chronic Pain Screening tool in HIV-infected patients, and conduct qualitative interviews to learn more about the pain experience in HIV-infected patients.  Her long-term interests are in understanding the relationship between chronic pain, alone and in the context of psychiatric illness and substance abuse, and HIV outcomes, and developing interventions to manage chronic pain in HIV-infected patients.

Mol Endocrinol. 2012 Nov 28. [Epub ahead of print]
The Role of Prolactin Receptor in GH Signaling in Breast Cancer Cells.
Xu J, Sun D
, Jiang J, Deng L, Zhang Y, Yu H, Bahl D, Langenheim JF, Chen WY, Fuchs SY, Frank SJ.

BACKGROUND: Cooccurring pain, mood disorders, and substance abuse are common in HIV-infected patients. Our objective was to investigate the relationship between pain, alone and in the context of mood disorders and substance abuse, on clinic utilization, antiretroviral therapy adherence, and virologic suppression.

METHODS: Pain, mood disorders, and substance abuse were assessed at the first visit. No-show and urgent visits were measured over a 1-year period. Models were adjusted for age, race, sex, insurance status, CD4(+) T-lymphocyte count, and HIV risk factor.

RESULTS: Among 1521 participants, 509 (34%) reported pain, 239 (16%) had pain alone, 189 (13%) had pain and a mood disorder, and 30 (2%) had pain and substance abuse. In univariate models, participants with pain, mood disorders, and substance abuse had higher odds of a no-show visit than those without these conditions [odds ratio (OR), 1.4; 95% confidence interval (CI), 1.1-1.8; OR, 1.5; 95% CI, 1.2-1.9; OR, 2.0; 95% CI, 1.4-2.8, respectively]. In the multivariable model, pain increased the odds of a no-show visit only in participants without substance abuse (OR, 1.5; 95% CI, 1.1-1.9) and pain reduced the odds of a no-show visit in participants with substance abuse (OR, 0.5; 95% CI, 0.2-0.9; P for interaction = 0.0022).

CONCLUSIONS: In this study, pain increased the odds of no-show visits but only for participants without substance abuse. Because pain, mood disorders, and substance abuse are highly prevalent in HIV-infected patients, our findings have implications for HIV treatment success. Interventions that incorporate pain management may be important for improving health outcomes in patients living with HIV infection.

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