Opioid Agonist Treatment Improves Antiretroviral Treatment Engagement and Outcomes

People who inject drugs (PWID) are at risk for HIV infection. In addition to other benefits, opioid agonist treatment (OAT) has the potential to improve antiretroviral treatment (ART) engagement and outcomes. The authors conducted a systematic review examining the impact of OAT on ART. They found 32 observational studies that met their criteria with 36,327 participants and a median follow-up of 24 months.

• OAT was associated with increased odds of being prescribed ART (odds ratio [OR], 1.5), adherence to ART (OR, 2.1), and HIV suppression (OR, 1.5). Receipt of OAT was associated with a decreased odds of ART discontinuation (OR, 0.8).
• The review failed to find a significant association between OAT and CD4 counts or mortality.

Comments:

This study adds to the growing evidence that OAT helps engage PWID in treatment of other conditions. Most of the studies included in this review were of individuals receiving methadone; we need more research on the impact of buprenorphine, especially since it can be more easily integrated with treatment of other medical conditions. Moreover, integration of OAT with other medical treatment may further improve treatment engagement and outcomes. In any case, providing access to OAT should be part of the standard of care of treatment of people with HIV and opioid use disorder.

Darius A. Rastegar, MD

Reference:

Low AJ, Mburu G, Welton NJ, et al. Impact of opioid substitution therapy on antiretroviral therapy outcomes: a systematic review and meta-analysis. Clin Infect Dis. 2016;63:1094–1104.