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（PLWHs）参与或继续接受艾滋病毒护理的可能性大大降低，并且不太可能实现病毒抑制。 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药物制剂为增加患者参与艾滋病毒护理连续体提供了机会。 最近开发的丁丙诺啡制剂提供了戒断抑制和阿片样物质阻断的连续窗口。 这可能导致多个方面的稳定行为周期，包括更好地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，以及更稳定地维持病毒载量的抑制。 在这项试点研究中，多达60名艾滋病毒治疗中的艾滋病病毒携带者，他们也在寻求阿片类药物使用障碍的治疗，将被随机分配到皮下长效丁丙诺啡注射或常规治疗（例如，转诊至标准的基于办公室的丁丙诺啡治疗），同时继续抗逆转录病毒治疗。 在12个月的时间里，我们将监测HIV-1 RNA水平、CD 4淋巴细胞计数、ART依从性、HIV护理保留率以及避免传播风险行为。 我们假设，与常规治疗相比，长效丁丙诺啡将改善对HIV护理连续体的参与，特别是在病毒抑制的稳定性方面。 我们一直在与丁丙诺啡长效皮下制剂的制造商合作，以获得启动合作试验的材料。 我们希望当我们能够恢复面对面的人类研究时，进展会继续下去。

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.