Opioid Agonist Treatment is Associated With Viral Suppression Among Women With HIV and Opioid Use Disorder

The goal of antiretroviral treatment (ART) is suppression of HIV. Previous studies have found lower rates of suppression among women, particularly those with illicit drug use. This study examined data from a cohort of people living with HIV and illicit drug use* in Vancouver, Canada. The authors sought to investigate the association between receiving opioid agonist treatment (OAT), which was presumed to be evidence of opioid use disorder (OUD), and viral rebound among women with HIV who achieved viral suppression on ART.

• There were 185 women included from the cohort who achieved viral suppression; of these, 62 (34%) experienced at least one viral rebound event (defined as a viral load >1,000 copies/mL).
• In multivariable analyses, stimulant use was associated with an increased risk of viral rebound (adjusted hazard ratio [aHR], 2.35).
• The only protective factor was receiving OAT (aHR, 0.46), but the effect was attenuated when adherence was factored in (aHR, 0.57).

* In this study classified as injection drug use, heroin use, and stimulant use in the last 6 months.

Comments: This study adds to the growing evidence of the benefits of OAT for OUD on the treatment of other chronic medical conditions. These results support the integration of OAT into regular medical care, especially for individuals with HIV infection, where adherence to treatment is vitally important.

Darius A. Rastegar, MD

Reference: Adams JW, Marshall BDL, Mohd Salleh NA, et al. Receipt of opioid agonist treatment halves the risk of HIV-1 RNA viral load rebound through improved ART adherence for HIV-infected women who use illicit drugs. Drug Alcohol Depend. 2020;206:107670.