Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders

Abstract

The opioid epidemic has had a significant, negative impact in the United States, and people living with HIV/AIDS (PLWHA) represent a vulnerable sub-population that is at risk for negative sequela from prolonged opioid use or opioid use disorder (OUD). PLWHA are known to suffer from HIV-related pain and are commonly treated with opioids, leading to subsequent addictive disorders. PLWHA and OUD are at an increased risk for attrition in the HIV care continuum, including suboptimal HIV laboratory testing, delayed entry into HIV care, and initiation or adherence to antiretroviral therapy. Barriers to OUD treatment, such as medication-assisted therapy, are also apparent for PLWHA with OUD, particularly those living in rural areas. Additionally, PLWHA and OUD are at a high risk for serious drug–drug interactions through antiretroviral-opioid metabolic pathway-related inhibition/induction, or via the human ether-a-go-go-related gene potassium ion channel pathways. HIV-associated neurocognitive disorders can also be potentiated by the off-target inflammatory effects of opioid use. PLWHA and OUD might require more intensive, individualized protocols to sustain treatment for the underlying opioid addiction, as well as to provide proactive social support to aid in improving patient outcomes. Advancements in the understanding and management of PLWHA and OUD are needed to improve patient care. This review describes the effects of prescription and non-prescription opioid use in PLWHA.

HIV, opioid use, and alterations to the gut microbiome: elucidating independent and synergistic effects

“…Understanding how HIV and opioid use, in combination, impact the microbiome is of growing importance, with the opioid epidemic leaving no populations untouched and opioids still widely used in clinical settings for pain management ( 76 ). In addition, those living with both HIV and OUD are more likely to receive suboptimal HIV testing and delayed entry into HIV care and treatment, and less likely to be adherent to ART treatment ( 16 ). Of note, opioids and MAT can also interact with and reduce the efficacy of ART ( 16 ).…”

“…Notably, PLWH are likely to have chronic pain and receive higher doses of opioids that put them at increased risk for opioid use disorder (OUD) ( 15 ). Of note, though opioids are the gold standard for pain management in the clinical setting, opioid use is associated with poorer outcomes in PLWH ( 16 ). Furthermore, high risk behaviors, such as recreational drug use, can put patients at additional risk for both HIV infection and OUD.…”

Emergence and Evolution of Big Data Science in HIV Research: Bibliometric Analysis of Federally Sponsored Studies 2000-2019

“…SDOH characteristics of risk populations and effective intervention strategies remain unknown 11,16,17 . To address these gaps, a research agenda is needed to harness socio-behavioral data and integrate them with existing EHR.…”

Importance of pharmacist-patient relationship in people living with HIV and concomitant opioid use disorder

“…People living with HIV/AIDS (PLWHA) are at high risk for poor outcomes when using chronic opioids, which can include clinically significant drug-drug interactions, decreased antiretroviral (ARV) adherence, or lead to other recreational substance use that may contribute to morbidity and reduced survival. 1 , 2 , 3 It is estimated that 21–95% of PLWHA are prescribed opioids for chronic pain management, 4 which can subsequently progress to opioid use disorder (OUD) or other substance misuse. Pharmacists are key members of the healthcare team and can improve PLWHA outcomes through ARV selection and optimization, drug counseling, and monitoring.…”

“… 5 While medications to treat OUD and other opioid rehabilitative services exist, healthcare disparities and access to addiction specialists disproportionally impact underserved populations like PLWHA. 3 Community pharmacists are highly accessible healthcare providers that have the opportunity to educate and potentially mitigate OUD or prevent opioid misuse in at risk individuals, however, pharmacists may be an underutilized resource in PLWHA. 6 , 7 The American Society of Health System Pharmacist Guidelines on Pharmacist Involvement in HIV Care suggest pharmacists should be active in screening for substance use disorders and collaborate with additional specialists.…”