Antiretroviral and Opioid Agonist Treatment Improve Survival Among People With HIV Who Inject Drugs

People who inject drugs (PWID) have an increased risk of acquiring HIV. Researchers recruited “network units”—PWID who have HIV along with ≤5 uninfected injection partners—in Ukraine, Indonesia, and Vietnam. Network units were randomly assigned to receive either: 1) standard care (referrals to existing HIV and opioid agonist treatment [OAT] clinics and standard harm-reduction services—including risk counseling, treatment of other infections, and syringe-service programs); or 2) the intervention (standard care plus systems navigation and psychosocial counseling sessions to facilitate initiation and engagement with HIV care and OAT). Included in the analysis were 502 PWID who had HIV along with 806 uninfected injection partners. They were followed for 12–24 months.

  • At week 26, the intervention participants were more likely to be receiving antiretroviral treatment (73% versus 36%), to have a suppressed HIV viral load (36% versus 16%), and to be receiving OAT (38% versus 24%), compared with controls.
  • Mortality was significantly lower in the intervention group, compared with controls (5.6 versus 12.1 deaths per 100 person-years; hazard ratio, 0.47).
  • There were 7 new HIV infections among the injection partners in the control group compared with none in the intervention group; this difference was not statistically significant.

Comments: This feasibility study shows that a fairly straightforward intervention that focuses on engagement with HIV care and OAT can help improve the health and decrease mortality of PWID who also have HIV. This intervention likely also reduces further transmission, but the study was not powered to assess this.

Darius A. Rastegar, MD

Reference: Miller WC, Hoffman IF, Hanscom BS, et al. A scalable, integrated intervention to engage people who inject drugs in HIV care and medication-assisted treatment (HPTN 074): a randomised, controlled phase 3 feasibility and efficacy study. Lancet. 2018;392:747–759.

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