The Effect of Buprenorphine on HIV RNA Load Distribution and Viral Suppression

Embargo until
2024-05-01
Date
2020-04-28
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Publisher
Johns Hopkins University
Abstract
Opioid use is prevalent among people with HIV (PWH) and can delay time to viral suppression. Use of buprenorphine (BUP), an opioid agonist therapy, may improve HIV outcomes in HIV care settings. We estimated the marginal distribution of HIV viral loads and the prevalence of viral suppression by BUP status. In the Johns Hopkins HIV Clinical Cohort, we identified 279 PWH who initiated BUP between 2002-2019. We also randomly chose 2,422 people among those without a history of BUP use whose viral load measurement periods overlapped with the BUP initiation dates of the BUP treatment group (matched control group). A BUP period was defined as a continuous BUP prescription with gaps less than 30 days. We used quantile regression and Poisson regression with robust variance to estimate quantiles or the prevalence of viral suppression across four thresholds (50, 200, 400, and 1500 copies/mL). We used the prior event rate ratio (PERR) methods to estimate the adjusted prevalence ratio accounting for unmeasured confounders. We included CD4, sex, race, age, injection drug use, male-to-male intercourse, and days before and after BUP initiation as covariates. The treatment and matched control groups consist mostly of black and male people. The median number of BUP periods per person was 1 (interquartile range (IQR): [1, 2]). The estimated 3rd quartile of HIV viral load was significantly lower while on BUP than before. The prevalence ratios comparing after BUP initiation with before were 1.19 (95% CI: [0.92, 1.53]), 1.19 (95% CI: [1.03, 1.37]), 1.19 (95% CI: [1.04, 1.36]), and 1.16 (95% CI: [1.04, 1.28]) with respective thresholds. The estimated prevalence ratios comparing viral loads while on BUP periods with those before BUP initiation tend to be higher across time. Including antiretroviral therapy in the models attenuated the estimates. The PERR-ALT adjusted prevalence ratio comparing the treatment group with the matched control group estimated with a 1500 copies/mL threshold was 1.08 (95% CI: [1.02, 1.14]). The estimated shift of the viral load distribution and the higher prevalence of viral suppression suggest using BUP within HIV clinical settings is expected to improve HIV outcomes of people with OUD.
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Keywords
buprenorphine, HIV, opioid use disorder
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