Buprenorphine treatments for opioid use disorder (OUD) among people living with HIV demonstrated beneficial effects in terms of viral load, according to results of a study presented at the virtual Conference on Retroviruses and Opportunistic Infections, held from March 8 to 11, 2020.
Investigators identified 207 people with HIV who started buprenorphine treatment between 2002 and 2018 at the Johns Hopkins Hospital HIV Clinic Cohort. The majority of the cohort were men (69%) and were black (88%); the cohort had a median age of 49 years.
The study allowed for multiple number of treatment episodes, which were defined as continuous buprenorphine prescription with gaps < 30 days. Individuals in the study had a median of 1 (interquartile range [IQR], 1-2) treatment episodes. The median viral loads before and after initial treatment were 80 copies/mL (IQR, 50-6690) and 50 copies/mL (IQR, 50-1721), respectively.
Researchers also employed a quantile liner model to assess the relationship between buprenorphine and viral load. The model considered skewed distribution and the large percentage of individuals who were suppressed, as well as time-varying treatment status.
The estimated differences in the four quantiles comparing before and after treatment were 25%: 0 (95% CI, -4.675 to 3.889); 50%: -43.94 (95% CI, -156.7 to 1.208); and 75%: -4360 (95% CI, -10930 to -195.8). After treatment, roughly 74% of viral loads were below 1500 copies/mL, which is a meaningful cut-off for the risk for HIV transmissibility, compared with 69% before treatment. Restricting the dataset to individuals who started treatment after 2011 similarly suggested differences of viral load in higher quantiles, but this analysis was limited by a small sample size.
Overall, the data suggested that buprenorphine treatment for OUD among people with HIV is likely to be beneficial by increasing the percentage of people with viral loads below 1500 copies/mL, potentially lowering the overall risk for HIV transmission.
Kim J, Chander G, Lesko CR, Fojo AT, Moore RD, Lau B. Buprenorphine treatment is related to decreased HIV RNA levels among people with HIV. Poster presented at: CROI 2020; March 8–11, 2020; http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 19, 2020.