by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

June 29, 2021

Featured Literature:

Kim J, Lesko CR, Fojo AT, et al. The effect of buprenorphine on HIV viral suppression. Clin Infect Dis. 2021 Jun 25; ciab578. doi: 10.1093/cid/ciab578. PMID: 34171087.

This analysis examined buprenorphine efficacy on viral suppression among people with HIV followed by the Johns Hopkins HIV Clinical Cohort (JHHCC). 279 participants initiating buprenorphine between 2002 and 2017 were matched with a comparison cohort (n=2422) of individuals who did not initiate buprenorphine; investigators also performed sensitivity analyses restricting the control group to people with injection drug use as HIV acquisition factor. [In 2009, a buprenorphine program was integrated into JHHCC’s clinical services, with prescriptions provided by designated on-site HIV providers coupled with on-site group counseling. Most participants filled buprenorphine prescriptions at the HIV clinic’s co-located pharmacy.] Overall, both buprenorphine initiation as well as period of time on buprenorphine were consistently associated with higher prevalence of viral suppression. Specifically, estimated prevalence was 14% higher after buprenorphine initiation and 19% higher at 90 days (comparing viral load measurements during periods participants were on buprenorphine, i.e. ‘BUP periods’, to measurements before buprenorphine initiation). Prevalence ratios were also noted to increase over time. Among participants not on ART at buprenorphine initiation, investigators observed a 31% increase in viral suppression prevalence.

Author’s Commentary:

These findings add to existing evidence associating buprenorphine with HIV care engagement as well as ART uptake and adherence, and the association between buprenorphine retention and viral suppression. Authors suggest, based on this analysis, buprenorphine may actually increase prevalence of viral suppression. Such a causal relationship would greatly strengthen the case and recommendations for integrated opioid use disorder treatment (OUD) and HIV care. Incorporation of buprenorphine into HIV care settings represents a uniquely powerful and life-saving opportunity to promote cross-disciplinary collaboration and training (e.g. increasing OUD management skills/knowledge among HIV providers and increasing HIV skills/knowledge among substance use providers). Recent changes in buprenorphine practice guidelines allow for an alternative notification of intent pathway for eligible providers seeking to treat up to 30 patients: now, such providers may forego previously-required federal certification requirements related to training, counseling, and other ancillary services (more information here). HIV clinicians and programs, especially those with limited local/specialty substance use referral networks, should strongly consider integrating substance use disorder treatment—especially OUD treatment—into their practices.

The author has no conflicts of interest to disclose.

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