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  Conference on Retroviruses
and Opportunistic Infections (CROI)
Boston, Massachusetts
March 4-7, 2018
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HIV Transmission Risk Higher With HIV+ Opioid Misusers,
Especially Injectors - less adherence, viral suppression/more condomless sex
  25th Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2018, Boston


Mark Mascolini
US adults with HIV who misuse opioids have higher rates of HIV transmission-risk behaviors and get infrequent counseling, according to a study of 28,000 people representing the US population in care for HIV [1]. People who inject opioids often share injecting equipment, a behavior further boosting their risk of transmitting HIV.
Centers for Disease Control and Prevention (CDC) researchers who conducted the study noted that people living with HIV get opioid prescriptions more often and at higher doses than HIV-negative people and so run a higher risk of opioid misuse, resulting poor adherence to antiretroviral therapy (ART), and potential HIV transmission. Ansley Lemons and a CDC team analyzed these issues in the Medical Monitoring Project, a surveillance system that collects data once yearly from a sample representing adults in HIV care across the United States.
This analysis used weighted, pooled data collected from June 2009 through May 2015 to estimate proportions and characteristics of opioid misuse, defined as any self-reported injection or noninjection use of prescription opioids or heroin for nonmedical purposes. Among 28,162 adults with HIV, 975 (3.5%) self-reported opioid misuse and 27,187 who did not. Among misusers, 64.8% misused prescription opioids, 29.1% used heroin, and 6.1% used both. Almost one quarter who misused opioids, 23.1%, injected them. Proportions of adults in care who misused opioids daily were 28.7% for injected drugs and 18.6% for noninjected drugs.
Compared with adults in HIV care who did not misuse opioids, those who did were significantly less likely to have antiretroviral-treatment characteristics linked to lower HIV transmission risk:
-- Less likely to have an ART prescription: 88.7% versus 92.5%
-- Less likely to adhere to ART: 78.1% versus 87.7%
-- Less likely to have durable HIV suppression: 58.5% versus 69.1%
Significantly higher proportions of opioid misusers than nonusers reported transmission risk behaviors:
-- Condomless sex with an HIV-negative or HIV status-unknown partner while not durably suppressed: 11.7% vs 3.4%, P < 0.001
-- Distributive syringe sharing: 16.6% vs 9.3%, P = 0.0245
-- Distributive sharing of other injection equipment: 21.2% vs 6.6%, P < 0.001
-- Shared syringes to divide drugs: 30.9% vs 18.9%, P = 0.0037
A significantly higher proportion of opioid misusers than nonusers received HIV or sexually transmitted infection (STI) prevention counseling from a nonclinician health workers, but only a little more than one third got such counseling: 38.3% versus 31.6% (P = 0.0002). Only about half in both groups got HIV or STI prevention counseling from a health care provider: 50.7% and 47.0% (P = 0.0578).
The CDC investigators concluded that opioid misuse is linked to ART factors and injection equipment practices that boost the risk of HIV transmission. They believe their findings "suggest a need for harm reduction services, including provision of syringe services programs, and increased HIV/STI prevention and drug counseling."
1. Lemons A, DeGroote N, Perez A, et al. HIV transmission risks among HIV-positive adults in medical care who misuse opioids. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 965.
Ansley Lemons1, Nicholas DeGroote1, Alejandro PĂ©rez1, Jason Craw1, Margaret Nyaku1, Dita Broz1, Christine Mattson2, Linda Beer1for the Medical Monitoring Project 1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention; 2Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention