HIV Infection and Depression Among Opiate Users in a US Epicenter of the Opioid Epidemic

Abstract

Using a mobile research facility, we enrolled 141 opioid users from a neighborhood of Philadelphia, an urban epicenter of the opioid epidemic. Nearly all (95.6%) met DSM-5 criteria for severe opioid use disorder. The prevalence of HIV infection (8.5%) was more than seven times that found in the general population of the city. Eight of the HIV-positive participants (67.0%) reported receiving antiretroviral treatment but almost all of them had unsuppressed virus (87.5%). The majority of participants (57.4%) reported symptoms consistent with major depressive disorder. Severe economic distress (60.3%) and homelessness were common (57%). Polysubstance use was nearly universal, 72.1% had experienced multiple overdoses and prior medication for opioid use disorder (MOUD) treatment episodes (79.9%), but few currently engaged in addiction care. The prevalence, multiplicity and severity of chronic health and socioeconomic problems highlight consequences of the current opioid epidemic and underscore the urgent need to develop integrated models of treatment. Keywords Opioid • HIV • Risk behavior • Depression • MOUD ResumenUtilizando un Centro de Investigación Móvil, inscribimos a 141 usuarios de opioides del vecindario de Filadelfia, un epicentro urbano de la epidemia de opioides. Casi todos (95,6%) cumplieron con los criterios del DSM-5 para el trastorno del uso severo del consumo de opioides. La prevalencia de la infección de VIH (8,5%) fue más‫ﹶ‬ de 7 veces superior a las encontrada en la población general de la ciudad. Ocho de los participantes con VIH positivo (67,0%) reportaron haber recibido tratamiento antirretroviral pero casi todos tuvieron virus no suprimido (87,5%). La mayoría de los participantes (57,4%) informaron síntomas compatibles con el Desorden Depresivo Mayor. La angustia severa por lo económico (60,3%) y las * Cecile M. Denis

Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs

“…More than half (55.2%) of individuals engaging in injection drug use have hepatitis C virus (HCV) [10][11][12]. Their suboptimal health outcomes are often perpetuated by structural harms, including limited resources, the ongoing overdose crisis, difficulty accessing treatment for substance use, and unstable housing [4,10,13]. A recent drop-in HIV clinic intervention among a cohort of housing unstable individuals with substance use disorder (SUD) and uncontrolled HIV in San Francisco reported only 44% viral suppression at 12 months [14].…”

Depressive-like Behavior Is Accompanied by Prefrontal Cortical Innate Immune Fatigue and Dendritic Spine Losses after HIV-1 Tat and Morphine Exposure

“…Not only can opioid misuse increase the risk of infection with bloodborne diseases such as HIV-1 [ 2 ], but opioids can worsen the pathogenesis of neuroHIV and HIV-associated neurocognitive disorders (HAND) [ 3 , 4 , 5 , 6 , 7 ]. OUD, HIV, and mood disorders are overlapping comorbidities [ 8 , 9 ] that can complicate treatment and lead to decreased medication adherence [ 9 ]. Importantly, the neuropathogenic mechanisms thought to underly HAND, and opioid exacerbation of neuroHIV (e.g., neuroinflammation [ 10 , 11 , 12 ] and synaptodendritic injury [ 13 , 14 , 15 ]) are also implicated in major depressive disorder (MDD).…”

Trajectories of depression among patients in treatment for opioid use disorder: A growth mixture model secondary analysis of the XBOT trial

“…Efforts to prioritize the evaluation of secondary outcomes in OUD trials 2 have been identified as an important next step for the field so that treatments may be better personalized 3 . Depression is one such secondary outcome that warrants special attention among individuals with OUD 4 because it is common in patients entering treatment, 5,6 related to higher healthcare costs, 7 and has been linked to increased rates of overdose 8 . Depressive disorders co‐occur in 15%–25% of individuals with OUD and 27%–61% of people who misuse opioids 9–11 .…”

“…3 Depression is one such secondary outcome that warrants special attention among individuals with OUD 4 because it is common in patients entering treatment, 5,6 related to higher healthcare costs, 7 and has been linked to increased rates of overdose. 8 Depressive disorders co-occur in 15%-25% of individuals with OUD and 27%-61% of people who misuse opioids. [9][10][11] Patients with cooccurring OUD and major depressive disorder (MDD) tend to have more difficulty in treatment and incur less favorable outcomes than patients without depression, 12 and there is a bidirectional relationship in that pre-existing OUD increases the risk of developing MDD and MDD is a vulnerability to subsequent OUD.…”