Opioid Agonist Treatment Improves Antiretroviral Medication Adherence Among People with Injection Drug Use and HIV

Injection drug use (IDU) is one of the major risk factors for HIV infection. Antiretroviral therapy (ART) reduces HIV morbidity, mortality, and transmission, but requires lifelong adherence to daily medications. Opioid agonist treatment (OAT) with methadone or buprenorphine may help improve adherence to HIV treatment. Researchers used a population-based database in British Columbia, Canada to investigate the association of OAT with ART adherence among a cohort of individuals with HIV and a history of IDU.

• Of 12,349 participants in the cohort, 2928 (24%) had a history of IDU; 1852 were included in the study with 39,375 person-months of follow up.
• OAT was associated with an unadjusted odds ratio (OR) of 1.54 for ≥ 95% ART medication refill adherence. The adjusted OR was 1.96.

Comments:

This study confirms prior observations of a positive effect of OAT on ART adherence. Other studies have shown that linking OAT with medical care facilitates both. There is an opportunity to improve HIV (and substance use disorder) outcomes by integrating OAT into HIV treatment; this should become a standard of care.

Darius A. Rastegar, MD

Reference:

Nosyk B, Min JE, Colley G, et al. The causal effect of opioid substitution treatment on HAART medication refill adherence. AIDS. 2015;29(8):965–973.