Medication for Opioid Abuse Linked to Better HIV Viral Suppression, ART Adherence

Patients with HIV who received medication for opioid use disorder (OUD) were found to be more likely to adhere to antiretroviral therapy (ART) and achieve viral suppression, according to a systematic review and meta-analysis published in Open Forum Infectious Disease.

Shared injection equipment has led to increases in blood-borne infectious diseases among people with OUD, and medication treatments for OUD (such as buprenorphine, methadone, and extended-release naltrexone) have been linked to reduced HIV and hepatitis C virus (HCV) risk behaviors and bacterial and fungal infection rates.

Investigators conducted a systematic literature search of studies in which patients aged 18 years and older had a diagnosis of either OUD or opioid dependence and at least 1 of the following diseases: HIV, HCV, hepatitis B virus (HBV), or endocarditis. The studies had to examine the effect of OUD medication treatments on ART adherence, HIV viral suppression; HCV sustained virologic response or reinfection; new HBV infection; or antimicrobial treatment completion, surgical outcomes, and reinfection rates for infective endocarditis. The investigators conducted a meta-analysis for ART adherence and HIV viral suppression outcomes.

A total of 9 articles were included in the final analysis. HIV viral suppression was the only outcome with enough studies to assess publication bias, and the funnel plot symmetry suggested that none existed. There were no studies for the outcome of new HBV infection.

All studies on HIV viral suppression (n=5) reported a significant relationship with patients undergoing medication management for OUD. Overall, the meta-analysis showed that patients receiving treatment for OUD had an increased odds of achieving HIV viral suppression (odds ratio [OR], 2.19; 95% CI, 1.88-2.56).

A meta-analysis of the 3 studies discussing ART adherence found that OUD patients on medication treatments had increased odds of adhering to ART (OR, 1.55; 95% CI, 1.12-2.15).

One study discussed the effects of buprenorphine on achieving sustained HCV virologic response; this study showed that patients with OUD on buprenorphine were significantly more likely than those who were never on buprenorphine to achieve sustained HCV virologic response (92% vs 64%) at 12 weeks, even when adjusted for HCV treatment adherence (P =.008).

Two studies were on infectious endocarditis. One study reported no significant difference in recurrence rates between patients with OUD who initiated medication treatment on admission for endocarditis (37.5%) and those who did not (40%) during a 45-month follow-up period. Another study reported no significant difference in antimicrobial completion between patients with OUD who were on medication treatments (87%) and those who were not (100%).

Study limitations included the small number of articles that met the inclusion criteria, which also did not allow for meta-analyses of the HCV- and endocarditis-related studies.

“Our results support the importance of integrating HIV and OUD treatment to increase the likelihood of achieving viral suppression,” the study authors wrote, emphasizing that viral suppression is the “most important goal of HIV treatment” in order to decrease HIV morbidity and mortality and decrease transmission rates.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of author disclosures. 

Reference

McNamara KF, Biondi BE, Hernandez-Ramirez RU, et al. A systemic review and meta-analysis of studies evaluating the effect of medication treatment for opioid use disorder on infectious disease outcomes. Open Forum Infect Dis. Published online June 2, 2021. doi:10.1093/ofid/ofab289