Combination treatment for opioid use disorder, HIV improves virus suppression, ART adherence

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Springer reports that he has received fees from Alkermes for scientific advice and donations in kind for study drugs for NIH-sponsored studies by Alkermes and Indivior.

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Integrating opioid use disorder drugs into HIV treatment improves viral suppression and ART adherence in people with HIV and opioid use disorder, according to study results published in the Open Forum Infectious Diseases.

According to Sandra A. Jumper, MD, Associate Professor of Medicine at the Yale School of Medicine, opioid use in the United States has increased since the late 1990s, with synthetic opioids – fentanyl – responsible for most of the deaths from overdose.

The number of overdose deaths rose to 90,000 in 2020 – at least an 18% increase from 2019 – and many states saw an increase of more than 50% in a year, with the deadliest month being May 2020 at the height of COVID- 19 pandemic was. Springer said Healio.

“In addition, infections related to opioid addiction and / or injection drug use are increasing across the country, including endocarditis and osteomyelitis, as well as acute hepatitis C virus infections and HIV,” said Springer.

She said her work at the intersection of HIV and opioid addiction has shown that integrating opioid use disorder (OUD) treatment into clinical trials improves HIV outcomes.

“Few places actually incorporate FDA-approved drug treatment for opioid use disorder (MOUD) and infectious disease treatment for OUD to improve infectious disease outcomes in some of the key infections identified.”

According to Springer, the researchers narrowed their search to studies that only evaluated people with OUD, not just anyone who had injected drug use, that compared the use of any of the three forms of MOUD to an infectious disease outcome they defined. In total, they identified 8,169 papers and included nine in the final review.

The meta-analysis showed that MOUD increased the likelihood of ART adherence (OR = 1.55; 95% CI 1.12-2.15) and HIV virus suppression (2.19; 95% CI 1.88-2.56 ) elevated. According to the study, one paper also suggested a positive association between MOUD and HCV-SVR.

“There is significant support for integrating MOUD into HIV treatment to improve viral suppression in those with HIV and those with opioid addiction. Integrating opioid addiction treatment into drug treatment combined with HIV treatment in people with HIV should be a priority in addressing the opioid and HIV epidemics, “said Springer. “This integrated treatment approach is also in line with the US Plan to End the HIV Epidemic to Reduce 90% of New Infections by 2030 by Assisting Treatment as Prevention Goals.”

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Ayesha A. Appa, MD

McNamara and colleagues conducted an important systematic review and meta-analysis that gathered evidence that linked MOUD primarily to HIV outcomes. The results of hepatitis and endocarditis were also examined, but fewer studies were found whose study design was suitable for inclusion in the meta-analysis. In particular, they found that MOUD was linked to HIV virus suppression and adherence to antiretroviral treatment. While MOUD arguably encompasses some of the most potent drugs used in our field, with very few numbers required to treat a significant mortality benefit, the treatment cascades for both OUD and HIV treatments are still pitifully incomplete. This work gives even more impetus to clinicians in all disciplines (particularly those dealing with HIV / infectious diseases) to include the treatment of OUD in their HIV treatment. Notably, people living with HIV and stimulant use disorders also face significant barriers to successful HIV treatment due to inadequate support for methamphetamine and cocaine use disorders, which is an important area for future studies.

Ayesha A. Appa, MD

Scholarship holder for infectious diseases and addiction medicine

University of California, San Francisco

Disclosure: Appa does not report any relevant financial information.

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