Laura Fanucchi1,2, Sandra A Springer3,4, P Todd Korthuis5. 1. Division of Infectious Disease, University of Kentucky College of Medicine, 740 South Limestone, K512, Lexington, KY, 40536, USA. laura.fanucchi@uky.edu. 2. Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, USA. laura.fanucchi@uky.edu. 3. Department of Internal Medicine, Section of Infectious Disease, Yale School of Medicine, New Haven, CT, USA. 4. Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA. 5. Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
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. 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.
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-releasenaltrexone 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-releasenaltrexone has been most extensively studied in persons with HIV leaving incarcerated settings, and improves HIV viral suppression in that context. 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.
Entities:
Keywords:
Buprenorphine; Extended-release naltrexone; HIV; MAT; Medication for opioid use disorder; Methadone; Opioid addiction; Opioid use disorders
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