Federal and State Action Needed to End the Infectious Complications of Illicit Drug Use in the United States: IDSA and HIVMA’s Advocacy Agenda

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Background Persons who inject drugs are at increased risk for acquiring hepatitis C virus (HCV). Medications for opioid use disorder (MOUD) are associated with reduced injection drug use (IDU) frequency among persons with opioid use disorder (OUD). However, whether HCV treatment uptake or changes in IDU frequency differ by HIV serostatus among persons receiving MOUD is incompletely understood. Methods A secondary analysis was performed of data collected from two prospective cohort studies of participants with (PWH) or without HIV with DSM-5 diagnosed OUD who were initiated on methadone, buprenorphine, or naltrexone. Results Of 129 participants, 78 (60.5%) were HCV antibody positive. PWH underwent increased HCV viral load testing (76.7% vs. 43.3%, p = 0.028), but HCV treatment rates did not differ (17.6% vs. 10.0%, p = 0.45) by HIV status. Participants without HIV reported a greater reduction in mean opioid IDU at 90 days (10.7 vs. 2.0 fewer days out of 30, p < 0.001) but there were no group differences at 90 days. Stimulant use did not differ between groups. Urine opioid positivity declined from baseline to 90 days among the entire cohort (61.4% to 38.0%, p < 0.001) but did not differ by HIV serostatus. Conclusions PWH who received MOUD underwent higher rates of follow-up HCV testing, but HCV treatment rates did not significantly differ by HIV serostatus. Participants without HIV on MOUD reported a greater reduction in opioid IDU. Improved integration of concomitant OUD with HCV and HIV screening, linkage to care and treatment is needed for persons without HIV.

Section: Discussionmentioning

confidence: 99%

Evaluation of the Impact of HIV Serostatus on the Hepatitis C Virus Care Cascade and Injection Drug Use Among Persons Initiating Medication Treatment for Opioid Use Disorder

Lier

Wyk

Paola

et al. 2022

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“…Persons who are actively using drugs are historically less likely to be adherent to ART, and the incorporation of OUD treatment in HIV care can be crucial to medication adherence and thus achieving viral suppression [ 30 ]. Given that the most important goal of HIV treatment is to attain viral suppression for reduction in individual morbidity and mortality and improvement of public health through reduction in transmission (Undetectable = Untransmittable, U = U), integration of OUD and HIV treatment is critical [ 3 , 10 , 12 , 13 ]. This systematic review and meta-analysis adds to the existing compelling evidence that it is possible and encouraged to address the intersectionality of the opioid and HIV epidemics.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes

McNamara

Biondi

Hernández-Ramírez

et al. 2021

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The opioid epidemic has fueled infectious disease epidemics. We determined the impact of medications for opioid use disorder (OUD; MOUD) on treatment outcomes of OUD-associated infectious diseases: antiretroviral therapy (ART) adherence, HIV viral suppression, hepatitis C (HCV) sustained virologic response, HCV re-infection, new HBV infections, and infectious endocarditis-related outcomes. Manuscripts reporting on these infectious disease outcomes in adults with OUD receiving MOUD compared with those with OUD not receiving MOUD were included. Initial search yielded 8,169 papers; 9 were included in the final review. The meta-analysis revealed that MOUD was associated with greater ART adherence (OR=1.55; 95%CI=1.12-2.15) and HIV viral suppression (2.19; 1.88-2.56). One study suggested a positive association between MOUD and HCV sustained virologic response. There is significant support for integrating MOUD with HIV treatment to improve viral suppression among persons with HIV (PWH) and OUD. Treatment of OUD among PWH should be a priority in order to combat the opioid and HIV epidemics.

“…The opioid epidemic in the United States, overdoses, and the infectious complications of injection drug use are an American health crisis [ 43 ]. Although expanding access to community-based harm reduction programs and services and improving the care continuum for individuals with infectious diseases and substance use disorders are critical, a better understanding of the epidemiology of all of these related health events among PWID may provide a way to further mitigate morbidity and mortality among this underserved population.…”

Section: Discussionmentioning

confidence: 99%

The Dynamics of Infectious Diseases Associated With Injection Drug Use in Lawrence and Lowell, Massachusetts

Gonsalves

Paltiel

Thornhill

et al. 2021

There are a wide variety of infectious complications of injection drug use. Understanding the trajectory of these complications might inform the development of an early warning system for HIV outbreaks that occur regularly among people who inject drugs (PWID). A distributed lag Poisson regression model in the Bayesian setting was used to examine temporal patterns in the incidence of injection-associated infectious diseases and their association with HIV cases in Lawrence and Lowell, Massachusetts between 2005-2018. Current-month HIV counts are associated with fatal overdoses approximately 8 months prior, cases of infective endocarditis 10 months prior, cases of skin and soft tissue infections and incision and drainage procedures associated with these infections, 12 months prior. Collecting data on these other complications associated with injection drug use by public health departments may be important to consider as these complications may serve as input to a sentinel system to trigger early intervention and avert potential outbreaks of HIV.