Medications for Treatment of Opioid Use Disorder among Persons Living with HIV

Fanucchi, Laura; Springer, Sandra A.; Korthuis, P. Todd

doi:10.1007/s11904-019-00436-7

Cited by 57 publications

(32 citation statements)

References 51 publications

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“…147 However, multiple studies have found that treatment with methadone or buprenorphine is associated with improved HIV treatment outcomes and decreased all cause mortality. [148][149][150] A systematic review and meta-analysis of 32 studies found that treatment with methadone or buprenorphine enhanced patient recruitment on to antiretroviral therapy (hazard ratio 1.69, 1.32 to 2.15), adherence to antiretroviral therapy (odds ratio 2.14, 1.41 to 3.26), and HIV viral suppression (odds ratio 1.45, 1.21 to 1.73). 150 Chronic HCV infection is common among people with OUD, especially those with a history of injecting drug use.…”

Section: Special Populationsmentioning

confidence: 99%

“…Moreover, people with SUD have been found to have decreased rates of appropriate CD4 cell monitoring (80.0% v 70.9%; P=0.001), appropriate pneumocystis pneumonia prophylaxis (95.0% v 90.1%; P=0.016), HIV viral suppression (51.9% v 41.4%; P<0.001), and vaccinations (pneumococcal conjugate vaccine 23 vaccination rates 89.3% v 84.6%; P<0.001) 147. However, multiple studies have found that treatment with methadone or buprenorphine is associated with improved HIV treatment outcomes and decreased all cause mortality 148149150. A systematic review and meta-analysis of 32 studies found that treatment with methadone or buprenorphine enhanced patient recruitment on to antiretroviral therapy (hazard ratio 1.69, 1.32 to 2.15), adherence to antiretroviral therapy (odds ratio 2.14, 1.41 to 3.26), and HIV viral suppression (odds ratio 1.45, 1.21 to 1.73) 150…”

Section: Treatmentmentioning

confidence: 99%

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Treatment of opioid use disorder in primary care

Buresh

Stern

Rastegar

2021

BMJ

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Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality—notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.

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Section: Special Populationsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Treatment of opioid use disorder in primary care

Buresh

Stern

Rastegar

2021

BMJ

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“…There is a consensus that opioid substitution therapies; namely, buprenorphine and methadone, are associated with reductions in overdose and serious opioid-related acute care use compared with other treatments including among PLWH [ 80 , 81 ]. Moreover, both buprenorphine and methadone improve HIV viral suppression, adherence to antiretroviral therapy, and overall mortality for PLWH with opioid use disorder, along with improved stability and quality of life, reductions in opioid use and relapse, and reductions in the transmission of HIV infections to others [ 82 – 86 ]. Further, extended-release naltrexone has been studied in PLWH leaving incarcerated settings and improves HIV viral suppression in that context [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, both buprenorphine and methadone improve HIV viral suppression, adherence to antiretroviral therapy, and overall mortality for PLWH with opioid use disorder, along with improved stability and quality of life, reductions in opioid use and relapse, and reductions in the transmission of HIV infections to others [ 82 – 86 ]. Further, extended-release naltrexone has been studied in PLWH leaving incarcerated settings and improves HIV viral suppression in that context [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

African American/Black and Latino Adults with Detectable HIV Viral Load Evidence Substantial Risk for Polysubstance Substance Use and Co-occurring Problems: A Latent Class Analysis

et al. 2021

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Substance use problems are highly prevalent among persons living with (PLWH) in the United States and serve as serious barriers to engagement in HIV care. Yet, in contrast to studies of single substances, little is known about patterns of polysubstance use in this population. Moreover, other risk factors (e.g., financial hardship, incarceration, homelessness, and mental health distress) are also prevalent and complicate HIV management. The present study drew on a cross-sectional survey with African American/Black and Latino (AABL) adult PLWH from low socioeconomic status backgrounds in New York City who were insufficiently engaged in HIV care and evidenced detectable HIV viral load ( N = 512). We used latent class analysis (LCA) to explore patterns of polysubstance use and their relationships to financial hardship, incarceration, homelessness, and mental health. LCA yielded three substance use classes: Class 1, a high polysubstance use/high-risk substance use class (9%); Class 2, a polysubstance use/moderate substance use risk class (18%); and Class 3, a moderate polysubstance use/moderate-to-low-risk substance use class (74%). Mental health symptoms were prevalent in all classes, but Class 1 had greater mental health distress than the other two classes. Current homelessness was more prevalent in Classes 1 and 2. We cannot end the HIV epidemic without engaging and treating AABL PLWH who have serious barriers to engagement along the HIV care continuum, and who evidence polysubstance use along with co-occurring risk factors. Clinical settings can develop outreach and engagement approaches to bring this subpopulation of PLWH into care settings, and further, specialized services are needed to successfully screen, treat, and retain them.

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“…In neglecting the general population for prevention messaging in favour of key populations, we exclude both those who are not easily reached by more targeted communication strategies and those who can help catalyze and sustain a supportive and enabling environment. This applies as much to biomedical prevention interventions [28] as to condom promotion.…”

Section: Plos Onementioning

confidence: 99%

Social representations of the prevention of heterosexual transmission of HIV among young Africans from five countries, 1997-2014

et al. 2020

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HIV prevention has evolved dramatically since the 1990s. The ABC trilogy (abstinence, be faithful, use a condom) has expanded to incorporate a range of biomedical prevention strategies, including voluntary medical male circumcision, pre-and post-exposure prophylaxis, and treatment-as-prevention, and to accommodate structural and combination prevention approaches. This study examines how young Africans from five epidemiologically and socio-culturally diverse countries (Swaziland, Kenya, Nigeria, Burkina Faso and Senegal) made sense of the evolving prevention of sexual transmission of HIV between 1997 and 2014. It uses a distinctive data source: 1,343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10-24. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. Over time, HIV prevention themes become less prominent. Condoms are represented less often from 2008, though representations become more favourable. Biomedical prevention is all but absent through 2014. While prevention strategies may be described as effective in narratorial commentary, they are rarely depicted as preventing HIV, but are evoked instead in moralistic cautionary tales or represented as ineffective. Over time, an increasing proportion of protagonists are female. One in five narratives acknowledge structural drivers of HIV, but these are generally either disempowering or condemn characters for failing to prevent HIV in the face of often overwhelming structural challenges. In the context of combination prevention, there is a need to disseminate an empowering cultural narrative that models successful use of HIV prevention strategies despite structural constraints and avoids blaming and stigma.

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Medications for Treatment of Opioid Use Disorder among Persons Living with HIV

Cited by 57 publications

References 51 publications

Treatment of opioid use disorder in primary care

Treatment of opioid use disorder in primary care

African American/Black and Latino Adults with Detectable HIV Viral Load Evidence Substantial Risk for Polysubstance Substance Use and Co-occurring Problems: A Latent Class Analysis

Social representations of the prevention of heterosexual transmission of HIV among young Africans from five countries, 1997-2014

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