HIV Patients Misusing Opioids Have Poorer Health Outcomes

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Researchers found substantial room for improvement in the delivery of substance use and mental health counseling and treatment and HIV/STD prevention counseling.

Among adults receiving medical care for HIV, misusing opioids is associated with inadequate antiretroviral therapy (ART) adherence, insufficient durable viral suppression, and an increased risk of HIV transmission to sexual partners, according to results published in the Journal of Acquired Immune Deficiency Syndromes.

The study included a probability sample of 28,162 HIV-positive adults receiving medical care in the United States who misused opioids (n=975). The researchers calculated weighted percentages and 95% confidence intervals to estimate substance use characteristics. They then used Rao-Scott chi-square tests to assess bivariate associations between opioid misuse and selected characteristics.

The researchers estimated that 3.3% of adults receiving HIV care in the United States misused opioids (95% CI, 3.0-3.6). In total, 2.1% (95% CI, 1.9-2.4) misused prescription opioids, 1% (95% CI, 0.8-1.1) used heroin, and 0.2% (95% CI, 0.1-0.3) reported using both. Among participants who reported any opioid misuse, 64.8% reported misusing prescription opioids, 29.1% reported using heroin, and 6.1% reported using both.

Participants who misused opioids were less likely to have been prescribed ART (88.7%), report being adherent to ART medications in the past 3 days (78.1%), and have durable viral suppression (58.5%) compared with participants who did not misuse opioids (92.5%, 87.7%, and 69.1%, respectively).

Compared with participants who did not misuse opioids, those who misused opioids were also more likely to report having sex without a condom with partners of negative or unknown HIV status while not durably virally suppressed (3.4% vs 11.7%).

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“We found substantial room for improvement in the delivery of substance use and mental health counseling and treatment and HIV/sexually transmitted disease  prevention counseling,” the researchers wrote. “We identified more homelessness, less access to and adherence to ART, and lower access to free needles and injection equipment; thus, improvements in these areas may reduce the risk for opioid misuse and HIV transmission.”


Lemons A, DeGroote N, Peréz A, et al. Opioid misuse among HIV-positive adults in medical care: results from the medical monitoring project, 2009-2014 [published online October 23, 2018]. J Acquir Immune Defic Syndr. doi:10.1097/QAI.0000000000001889