Combining treatment for opioid use disorder, HIV improves viral suppression, ART adherence
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Integrating medications for opioid use disorder with HIV treatment improves viral suppression and ART adherence among people with both HIV and opioid use disorder, study findings published in Open Forum Infectious Diseases showed.
According to Sandra A. Springer, MD, associate professor of medicine at the Yale School of Medicine, opioid use in the United States has been rising since the late 1990s, with synthetic opioids — fentanyl — accounting for most overdose deaths.
Overdose deaths rose to 90,000 in 2020 — at least an 18% increase over 2019 — and many states saw a more than 50% increase in 1 year, with the most deadly month being May 2020, during the height of the COVID-19 pandemic, Springer told Healio.
“In addition, infections related to opioid addiction and/or injection drug use are rising across the country, including endocarditis and osteomyelitis, as well as acute hepatitis C viral infection and HIV,” Springer said.
She said her work at the intersection of HIV and opioid addiction has demonstrated that integrating treatment for opioid use disorder (OUD) in clinical trials improves HIV outcomes.
“Few places are actually integrating FDA approved medication treatment for opioid use disorder (MOUD) and infectious disease treatment, so we sought to perform a systematic review and meta-analysis of any published study that actually evaluated the effect of any FDA-approved medication treatment for OUD to improve an infectious disease outcome of some of the key infections noted.”
According to Springer, the researchers narrowed their search to studies that evaluated only persons with OUD not just anyone who had injection drug use and that compared the use of one of the three forms of MOUD on an infectious disease outcome that they defined. Overall, they identified 8,169 papers and included nine in the final review.
The meta-analysis revealed that MOUD increased the odds of ART adherence (OR = 1.55; 95% CI, 1.12-2.15) and HIV viral suppression (2.19; 95% CI, 1.88-2.56). According to the study, one paper also suggested a positive association between MOUD and HCV SVR.
“There is significant support for integrating MOUD with HIV treatment to improve viral suppression among persons with HIV and those with opioid addiction. Integration of treatment of opioid addiction with medication treatment combined with HIV treatment among people with HIV should be a priority in order to combat the opioid and HIV epidemics,” Springer said. “This integrated treatment approach is also in line with the United States’ Ending the HIV Epidemic plan to reduce 90% of new infections by 2030 through helping with the treatment as prevention goals.”
Perspective
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McNamara and colleagues conducted an important systematic review and meta-analysis aggregating evidence relating MOUD to primarily HIV outcomes. Hepatitis and endocarditis outcomes were studied as well, but fewer studies could be found with study design suitable for inclusion in the meta-analysis. Notably, they found that MOUD was associated with HIV viral suppression and adherence to antiretroviral treatment. Although MOUD includes arguably some of the most effective medicines used in our field, with very low numbers needed to treat for a marked mortality benefit, the care cascades for both OUD and HIV management are yet woefully incomplete. This work adds even more impetus for clinicians across disciplines (particularly in HIV/infectious diseases) to incorporate treatment for OUD into HIV care. Of note, people living with HIV and stimulant use disorders also face considerable barriers to successful HIV treatment related to insufficient support for methamphetamine and cocaine use disorders, which is an important area for future study.
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