People living with HIV (PLWH) are more likely to be prescribed opioids and have higher prevalence of mental health and substance use disorders compared with those without HIV. Additionally, PLWH who have unhealthy opioid use are less likely to be prescribed standard HIV treatment, leading to adverse health outcomes. The authors of this study used data from the 2009–2014 cycles of the Medical Monitoring Project (MMP) to assess prevalence and correlates of unhealthy substance use among PLWH who had opioid misuse.* The MMP is a surveillance system collecting nationally representative data on the sociodemographic, clinical, and behavioral characteristics of adults receiving HIV care in the US.
- Of 28,162 PLWH included in the MMP, 3% (975) had opioid misuse.
- PLWH with opioid misuse were less likely to have been prescribed antiretroviral therapy (ART, 89% versus 93%), report being adherent to ART medications in the past 3 days (78% versus 88%), and have durable viral suppression (54% versus 65%), compared with PLWH who did not have opioid
- Among PLWH with opioid misuse, the prevalence of engaging in condomless sex with HIV-negative or unknown HIV status partners while not durably virally suppressed was more than 3 times greater than it was among those without opioid
* Defined as any self-reported injection use or use of prescription opioids for nonmedical purposes.
Comments: Although these data rely on patient self-report and a cross-sectional survey and therefore causation cannot be conclusively determined, this analysis is the first nationally representative survey of its kind. It adds to the growing body of literature suggesting the need for tailored treatment and risk reduction efforts for PLWH with opioid misuse.
Jeanette M. Tetrault, MD
Reference: Lemons A, DeGroote N, Peréz A, et al. Opioid misuse among HIV-positive adults in medical care: results from the Medical Monitoring Project, 2009–2014. J Acquir Immune Defic Syndr. 2019;80:127–134.