Optimizing HIV-care-continuum engagement and outcomes among opioid users

注射海洛因或其他阿片类药物的艾滋病毒感染者参与或继续接受艾滋病毒治疗的可能性大大降低，实现病毒学抑制的可能性也大大降低。与不注射毒品的艾滋病毒感染者相比，他们的艾滋病毒进展速度更快，死亡率更高。阿片类药物使用障碍的长效制剂提供了增加患者参与艾滋病毒护理连续体的机会。最近开发的丁丙诺啡制剂提供了一个持续的窗口戒断抑制和阿片类药物封锁。这可能导致在多个方面形成稳定行为的循环，包括更坚持抗逆转录病毒治疗（ART），更多地参加艾滋病毒临床护理预约，更一致地避免传播风险行为，以及更稳定地维持对病毒载量的抑制。

People living with HIV (PLWHs) who inject heroin or other opioids are substantially less likely to engage or be retained in HIV care and less likely to achieve virologic suppression. They also have faster rates of HIV viral progression and higher mortality compared to PLWHs who dont inject drugs. Long-acting formulations of medications for opioid-use disorder present an opportunity to increase patients engagement into the HIV care continuum. A recently developed formulation of buprenorphine provides a continuous window of withdrawal suppression and opioid blockade. This may lead to a cycle of stable behavior on multiple fronts, including greater adherence to antiretroviral therapy (ART), greater attendance to appointments for HIV clinical care, more consistent avoidance of transmission-risk behaviors, and more steadily maintained suppression of viral load. In this pilot study, up to 60 PLWHs in HIV treatment who are also seeking treatment for opioid-use disorder will be randomized to subcutaneous long-acting buprenorphine injections or treatment as usual (e.g., referral to standard office-based buprenorphine treatment) while ART is continued. Over 12 months, we will monitor HIV-1 RNA levels, CD4 lymphocyte count, ART adherence, retention in HIV care, and avoidance of transmission-risk behaviors. We hypothesize that long-acting buprenorphine, compared to treatment as usual, will improve engagement into the HIV care continuum, specifically in stability of viral suppression. We have been working with the manufacturer of a long-acting subcutaneous formulation of buprenorphine to obtain materials for initiation of a collaborative trial. We expect progress to continue when we can resume in-person human research.