HIV Treatment Initiation and Retention Among Individuals Initiated on Injectable Opioid Agonist Therapy for Severe Opioid Use Disorder: A Case Series

Abstract

Objectives: Injectable opioid agonist therapy (iOAT) has previously been demonstrated to be an effective treatment option for individuals with a severe opioid use disorder (OUD) who have been unsuccessful on first line therapy (eg, buprenorphine/naloxone or methadone). Many individuals with severe OUD may also have HIV infection. Despite this, no literature currently exists examining the relationship between antiretroviral therapy (ART) initiation and adherence following iOAT initiation in the outpatient setting. Methods: Retrospective case series (n = 3) of HIV-infected individuals with a severe OUD who were refractory to oral opioid agonist treatment and were started on iOAT in a community setting in Vancouver, Canada. Outcomes of interest included: (1) iOAT induction and maintenance dosing schedules; (2) ART adherence demonstrated by change in HIV viral load. Results: All 3 patients initiated and successfully reached iOAT maintenance doses with significant reduction in illicit opioid use. Stable iOAT was associated with increased ART initiation and adherence, and decreased HIV viral loads. Conversely, poor retention or discontinuation of iOAT was associated with reduced adherence to ART and in 1 patient, increased HIV viral loads. Conclusions: The individual cases presented suggest that among individuals with severe OUD and HIV infection, iOAT may improve HIV treatment uptake and retention in care.

Integrating long-acting injectable treatment to improve medication adherence among persons living with HIV and opioid use disorder: study protocol

“…Models of behavior change suggest that addressing multiple chronic conditions simultaneously through integrated, evidence-based interventions can have a synergistic effect resulting in improved healthrelated outcomes [23][24][25]. Consistent with this perspective, numerous studies have documented that receipt of medications for OUD in the context of HIV care is associated with treatment retention, ART adherence, and HIV viral suppression [26][27][28][29]. In light of the Ending the HIV Epidemic campaign to reduce new HIV infections in the United States by 90% by 2030 [30], there have been calls to develop integrated or co-located HIV and OUD services to expand access to care [31][32][33][34].…”