Effect of Buprenorphine on Viral Suppression in Patients With HIV Infection

Buprenorphine – strong opioid analgesic (painkiller) abstract.
Researchers conducted a study among patients with HIV infection to assess the effect of buprenorphine on HIV viral loads.

Buprenorphine (BUP) was found to increase the probability of achieving viral suppression in patients with HIV infection, according to results of longitudinal clinical cohort study, published in Clinical Infectious Diseases.

Researchers identified patients enrolled in the Johns Hopkins HIV Clinical Cohort study who initiated BUP between 2002 and 2017. They were matched against a second cohort (controls) of patients with HIV infection who did not initiate BUP. The researchers sought to assess the effect of BUP initiation on HIV viral loads. A temporary discontinuation of BUP use for 30 days or longer between 2 consecutive prescriptions was considered to be a single treatment period, and multiple treatment periods were permissible for each patient. Viral suppression was defined as an HIV viral load of less than 200 copies/mL.

Among patients in the BUP (n=279) and control cohorts (n=2422), the median age was 50 (IQR, 44-55) and 49 (IQR, 41-55) years, 67.4% and 63.6% were men, 87.8% and 74.0% were Black, 8.6% and 29.4% were men who have sex with men, 70.6% and 28.2% were injection drug users, 55.9% and 52.7% were on antiretroviral therapy (ART), and median CD4 counts were 346 and 476 cells/mL, respectively.

Among patients in the BUP cohort, 98% had opioid use disorder (OUD), 90.5% received BUP in addition to naloxone, and 9.5% received BUP alone. Within two years after the first BUP period, the median number of BUP periods was 1 (range, 1-8) and the median duration of a treatment period was 86 (IQR, 15-284) days.

The researchers found that the estimated prevalence of HIV viral suppression increased by 14% after BUP initiation (prevalence ratio [PR], 1.14; 95% CI, 1.01-1.30). Following BUP initiation, the estimated prevalence of HIV viral suppression increased by 19% after90 days (PR, 1.19; 95% CI, 1.06-1.34), with an additional increase observed after 730 days (PR, 1.33; 95% CI, 1.08-1.63).

Compared with patients in the control cohort, the prevalence of viral suppression was increased by 8% among those in the BUP cohort who were taking ART (P <.05). Of patients in the BUP cohort who were not taking ART at the time of BUP initiation, the prevalence of viral suppression increased by 31%.

This study was limited by the inclusion of only prescription data from the Johns Hopkins clinical pharmacy, thus patients who received a BUP prescription from other pharmacies may have been misclassified. In addition, data were unavailable to account for patients who stopped using BUP and subsequently initiated methadone treatment.

According to the researchers, “initiating and maintaining BUP among [patients with HIV infection] may not only decrease the risk [for] opioid-related adverse events, including overdose, but also improve individual HIV outcomes…and [decrease] the risk for HIV transmission through both HIV and OUD treatment as prevention.”


Kim J, Lesko CR, Fojo AT, et al. The effect of buprenorphine on human immunodeficiency virus viral suppression. Clin Infect Dis. 2021;73(11):1951-1956. doi:10.1093/cid/ciab578