Advertisement

Medications for Treatment of Opioid Use Disorder among Persons Living with HIV

  • Laura FanucchiEmail author
  • Sandra A. Springer
  • P. Todd Korthuis
Behavioral Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)
  • 98 Downloads
Part of the following topical collections:
  1. Topical Collection on Behavioral-Bio-Medical Interface
  2. Topical Collection on Behavioral-Bio-Medical Interface

Abstract

Purpose of Review

Recent HIV outbreaks have occurred as a result of the current US opioid epidemic. Providing medications for opioid use disorder (MOUD) with methadone, buprenorphine, and extended-release naltrexone is essential to achieving optimal HIV treatment outcomes including viral suppression and retention in treatment. This review describes the pharmacology of MOUD with specific attention to interactions with antiretroviral therapy, and to the effect of MOUD on HIV treatment outcomes.

Recent Findings

Methadone and buprenorphine both improve HIV viral suppression, adherence to antiretroviral therapy, and overall mortality for persons with opioid use disorder (OUD). Extended-release naltrexone has been most extensively studied in persons with HIV leaving incarcerated settings, and improves HIV viral suppression in that context.

Summary

Strategies that integrate MOUD and HIV treatment are crucial to optimize viral suppression. The differing pharmacokinetic and delivery characteristics of these MOUD offer diverse options. Given the chronic and relapsing nature of both HIV and OUD, long-term approaches are required.

Keywords

Extended-release naltrexone Methadone Buprenorphine HIV Opioid use disorders MAT Medication for opioid use disorder Opioid addiction 

Notes

Funding

US National Institutes of Health, National Institute on Drug Abuse (Korthuis: UG1DA015815, UG3DA044831, R01DA037441; Springer: K02DA032322).

Compliance with Ethical Standards

Conflict of Interest

Dr. Korthuis serves as principal investigator for NIH-funded clinical trials that receive donated study medication from Alkermes (extended-release naltrexone) and Inidivior (buprenorphine/naloxone). Dr. Fanucchi has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. Increases in Drug and Opioid Overdose Deaths - United States, 2000-2014. Morb Mortal Wkly Rep. 2016;64(50):1378–82.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention. Provisional Drug Overdose Death Counts, in Vital Statistics Rapid Release, N.C.f.H. Statistics, Editor. 2018.Google Scholar
  4. 4.
    Strathdee SA, Beyrer C. Threading the needle--how to stop the HIV outbreak in rural Indiana. N Engl J Med. 2015;373(5):397–9.CrossRefGoogle Scholar
  5. 5.
    Schumaker E. Opioids have sparked an HIV outbreak in Massachusetts, in Huffington Post. 2018.Google Scholar
  6. 6.
    •• Van Handel MM, et al. County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. J Acquir Immune Defic Syndr. 2016;73(3):323–31. This study is an evaluation of the US counties at highest risk of an HIV outbreak associated with injection drug use.CrossRefGoogle Scholar
  7. 7.
    Conrad C, Bradley HM, Broz D, Buddha S, Chapman EL, Galang RR, et al. Community outbreak of HIV infection linked to injection drug use of oxymorphone--Indiana, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(16):443–4.Google Scholar
  8. 8.
    Azar P, Wood E, Nguyen P, Luma M, Montaner J, Kerr T, et al. Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis. BMC Infect Dis. 2015;15:193.CrossRefGoogle Scholar
  9. 9.
    Zhang Y, Wilson TE, Adedimeji A, Merenstein D, Milam J, Cohen J, et al. The impact of substance use on adherence to antiretroviral therapy among HIV-infected women in the United States. AIDS Behav. 2018;22(3):896–908.CrossRefGoogle Scholar
  10. 10.
    • Low AJ, et al. Impact of opioid substitution therapy on antiretroviral therapy outcomes: a systematic review and meta-analysis. Clin Infect Dis. 2016;63(8):1094–104. This study is a review and meta-analysis of the impact of treatment with methadone and buprenorphine on HIV treatment outcomes.CrossRefGoogle Scholar
  11. 11.
    Springer SA, Chen S, Altice FL. Improved HIV and substance abuse treatment outcomes for released HIV-infected prisoners: the impact of buprenorphine treatment. J Urban Health. 2010;87(4):592–602.CrossRefGoogle Scholar
  12. 12.
    • Springer SA, et al. Extended-release naltrexone improves viral suppression among incarcerated persons living with HIV with opioid use disorders transitioning to the community: results of a double-blind, placebo-controlled randomized trial. J Acquir Immune Defic Syndr. 2018;78(1):43–53. This study demonstrates improved viral suppression with extended-release naltrexone compared to placebo in persons living with HIV leaving incarceration.CrossRefGoogle Scholar
  13. 13.
    MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ. 2012;345:e5945.CrossRefGoogle Scholar
  14. 14.
    Sordo L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.CrossRefGoogle Scholar
  15. 15.
    Metzger DS, Woody GE, McLellan A, O'Brien CP, Druley P, Navaline H, et al. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr. 1993;6(9):1049–56.Google Scholar
  16. 16.
    Sullivan LE, Moore BA, Chawarski MC, Pantalon MV, Barry D, O'Connor PG, et al. Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors. J Subst Abus Treat. 2008;35(1):87–92.CrossRefGoogle Scholar
  17. 17.
    Mattick RP, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2008;2:CD002207.Google Scholar
  18. 18.
    Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MC. QT-interval effects of methadone, levomethadyl, and buprenorphine in a randomized trial. Arch Intern Med. 2007;167(22):2469–75.CrossRefGoogle Scholar
  19. 19.
    Volpe DA, et al. Methadone metabolism and drug-drug interactions: in vitro and in vivo literature review. J Pharm Sci. 2018.Google Scholar
  20. 20.
    McCance-Katz EF. Treatment of opioid dependence and coinfection with HIV and hepatitis C virus in opioid-dependent patients: the importance of drug interactions between opioids and antiretroviral agents. Clin Infect Dis. 2005;41(Suppl 1):S89–95.CrossRefGoogle Scholar
  21. 21.
    McCance-Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2010;19(1):4–16.CrossRefGoogle Scholar
  22. 22.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.CrossRefGoogle Scholar
  23. 23.
    Kreek MJ, Borg L, Ducat E, Ray B. Pharmacotherapy in the treatment of addiction: methadone. J Addict Dis. 2010;29(2):200–16.CrossRefGoogle Scholar
  24. 24.
    Palepu A, Tyndall MW, Joy R, Kerr T, Wood E, Press N, et al. Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy. Drug Alcohol Depend. 2006;84(2):188–94.CrossRefGoogle Scholar
  25. 25.
    Once-monthly subcutaneous buprenorphine (Sublocade) for opioid use disorder. Med Lett Drugs Ther. 2018;60(1541):35–37.Google Scholar
  26. 26.
    Rosenthal RN, Lofwall MR, Kim S, Chen M, Beebe KL, Vocci FJ, et al. Effect of buprenorphine implants on illicit opioid use among abstinent adults with opioid dependence treated with sublingual buprenorphine: a randomized clinical trial. JAMA. 2016;316(3):282–90.CrossRefGoogle Scholar
  27. 27.
    Lofwall MR, Walsh SL, Nunes EV, Bailey GL, Sigmon SC, Kampman KM, et al. Weekly and monthly subcutaneous buprenorphine depot formulations vs daily sublingual buprenorphine with naloxone for treatment of opioid use disorder: a randomized clinical trial. JAMA Intern Med. 2018;178(6):764–73.CrossRefGoogle Scholar
  28. 28.
    Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, et al. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 2011;56(Suppl 1):S22–32.CrossRefGoogle Scholar
  29. 29.
    Fiellin DA, Weiss L, Botsko M, Egan JE, Altice FL, Bazerman LB, et al. Drug treatment outcomes among HIV-infected opioid-dependent patients receiving buprenorphine/naloxone. J Acquir Immune Defic Syndr. 2011;56(Suppl 1):S33–8.CrossRefGoogle Scholar
  30. 30.
    Korthuis PT, Fiellin DA, Fu R, Lum PJ, Altice FL, Sohler N, et al. Improving adherence to HIV quality of care indicators in persons with opioid dependence: the role of buprenorphine. J Acquir Immune Defic Syndr. 2011;56(Suppl 1):S83–90.CrossRefGoogle Scholar
  31. 31.
    Potter JS, Marino EN, Hillhouse MP, Nielsen S, Wiest K, Canamar CP, et al. Buprenorphine/naloxone and methadone maintenance treatment outcomes for opioid analgesic, heroin, and combined users: findings from starting treatment with agonist replacement therapies (START). J Stud Alcohol Drugs. 2013;74(4):605–13.CrossRefGoogle Scholar
  32. 32.
    Lucas GM, et al. Clinic-based treatment of opioid-dependent HIV-infected patients versus referral to an opioid treatment program: a randomized trial. Ann Intern Med. 2010;152(11):704–11.CrossRefGoogle Scholar
  33. 33.
    Korthuis PT, Tozzi MJ, Nandi V, Fiellin DA, Weiss L, Egan JE, et al. Improved quality of life for opioid-dependent patients receiving buprenorphine treatment in HIV clinics. J Acquir Immune Defic Syndr. 2011;56(Suppl 1):S39–45.CrossRefGoogle Scholar
  34. 34.
    Springer SA, Qiu J, Saber-Tehrani AS, Altice FL. Retention on buprenorphine is associated with high levels of maximal viral suppression among HIV-infected opioid dependent released prisoners. PLoS One. 2012;7(5):e38335.CrossRefGoogle Scholar
  35. 35.
    Krupitsky E, Nunes EV, Ling W, Illeperuma A, Gastfriend DR, Silverman BL. Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial. Lancet. 2011;377(9776):1506–13.CrossRefGoogle Scholar
  36. 36.
    Dijkstra BA, et al. Does naltrexone affect craving in abstinent opioid-dependent patients? Addict Biol. 2007;12(2):176–82.CrossRefGoogle Scholar
  37. 37.
    Minozzi S, et al. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev. 2011;4:CD001333.Google Scholar
  38. 38.
    Lee JD, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. Lancet. 2017.Google Scholar
  39. 39.
    Tanum L, Solli KK, Latif ZEH, Benth JŠ, Opheim A, Sharma-Haase K, et al. Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial. JAMA Psychiatry. 2017;74(12):1197–205.CrossRefGoogle Scholar
  40. 40.
    Tetrault JM, Tate JP, McGinnis KA, Goulet JL, Sullivan LE, Bryant K, et al. Hepatic safety and antiretroviral effectiveness in HIV-infected patients receiving naltrexone. Alcohol Clin Exp Res. 2012;36(2):318–24.CrossRefGoogle Scholar
  41. 41.
    Vagenas P, di Paola A, Herme M, Lincoln T, Skiest DJ, Altice FL, et al. An evaluation of hepatic enzyme elevations among HIV-infected released prisoners enrolled in two randomized placebo-controlled trials of extended release naltrexone. J Subst Abus Treat. 2014;47(1):35–40.CrossRefGoogle Scholar
  42. 42.
    Springer SA, di Paola A, Barbour R, Azar MM, Altice FL. Extended-release naltrexone improves viral suppression among incarcerated persons living with HIV and alcohol use disorders transitioning to the community: results from a double-blind, placebo-controlled trial. J Acquir Immune Defic Syndr. 2018;79(1):92–100.CrossRefGoogle Scholar
  43. 43.
    Springer SA, di Paola A, Azar MM, Barbour R, Krishnan A, Altice FL. Extended-release naltrexone reduces alcohol consumption among released prisoners with HIV disease as they transition to the community. Drug Alcohol Depend. 2017;174:158–70.CrossRefGoogle Scholar
  44. 44.
    Mitchell MC, Memisoglu A, Silverman BL. Hepatic safety of injectable extended-release naltrexone in patients with chronic hepatitis C and HIV infection. J Stud Alcohol Drugs. 2012;73(6):991–7.CrossRefGoogle Scholar
  45. 45.
    Korthuis PT, Lum PJ, Vergara-Rodriguez P, Ahamad K, Wood E, Kunkel LE, et al. Feasibility and safety of extended-release naltrexone treatment of opioid and alcohol use disorder in HIV clinics: a pilot/feasibility randomized trial. Addiction. 2017;112(6):1036–44.CrossRefGoogle Scholar
  46. 46.
    Clinical Trials Network-0067 Comparing Treatments for HIV-Infected Opioid Users in an Integrated Care Effectiveness Study (CHOICES) Scale-Up.Google Scholar
  47. 47.
    Dunbar JL, Turncliff RZ, Dong Q, Silverman BL, Ehrich EW, Lasseter KC. Single- and multiple-dose pharmacokinetics of long-acting injectable naltrexone. Alcohol Clin Exp Res. 2006;30(3):480–90.CrossRefGoogle Scholar
  48. 48.
    Alkermes Inc., Vivitrol package insert. 2010.Google Scholar
  49. 49.
    Saber-Tehrani AS, Bruce RD, Altice FL. Pharmacokinetic drug interactions and adverse consequences between psychotropic medications and pharmacotherapy for the treatment of opioid dependence. Am J Drug Alcohol Abuse. 2011;37(1):1–11.CrossRefGoogle Scholar
  50. 50.
    McCance-Katz EF, Rainey PM, Friedland G, Kosten TR, Jatlow P. Effect of opioid dependence pharmacotherapies on zidovudine disposition. Am J Addict. 2001;10(4):296–307.CrossRefGoogle Scholar
  51. 51.
    International Advisory Panel on HIV Care Continuum Optimization. IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Provid AIDS Care. 2015:1–32.Google Scholar
  52. 52.
    Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.CrossRefGoogle Scholar
  53. 53.
    Williams AR, Nunes E, Olfson M. To battle the opioid overdose epidemic, deploy the ‘Cascade of Care’ model. Health Affairs Blog. 2017.  https://doi.org/10.1377/hblog20170313.059163.
  54. 54.
    Socias ME, Volkow N, Wood E. Adopting the ‘cascade of care’ framework: an opportunity to close the implementation gap in addiction care? Addiction. 2016;111(12):2079–81.CrossRefGoogle Scholar
  55. 55.
    National Institute on Drug Abuse. Chart of Evidence-Based Screening Tools and Assessments for Adults and Adolescents. Revised June 2018. https://www.drugabuse.gov/nidamed-medical-health-professionals/tool-resources-your-practice/screening-assessment-drug-testing-resources/chart-evidence-based-screening-tools. Accessed 3 January 2019.
  56. 56.
    Korthuis PT, McCarty D, Weimer M, Bougatsos C, Blazina I, Zakher B, et al. Primary care-based models for the treatment of opioid use disorder: a scoping review. Ann Intern Med. 2017;166(4):268–78.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Laura Fanucchi
    • 1
    • 2
    Email author
  • Sandra A. Springer
    • 3
    • 4
  • P. Todd Korthuis
    • 5
  1. 1.Division of Infectious DiseaseUniversity of Kentucky College of MedicineLexingtonUSA
  2. 2.Center on Drug and Alcohol ResearchUniversity of Kentucky College of MedicineLexingtonUSA
  3. 3.Department of Internal Medicine, Section of Infectious DiseaseYale School of MedicineNew HavenUSA
  4. 4.Center for Interdisciplinary Research on AIDSYale University School of Public HealthNew HavenUSA
  5. 5.Section of Addiction MedicineOregon Health & Science UniversityPortlandUSA

Personalised recommendations