The Effect Of Buprenorphine On HIV Viral Suppression.

BACKGROUND Opioid use is prevalent among people with HIV and adversely affects HIV outcomes. We assessed the effect of buprenorphine (BUP) initiation on subsequent HIV viral loads. METHODS We identified people with HIV (PWH) from the Johns Hopkins HIV Clinical Cohort who initiated BUP between 2002-2017. Poisson regression with robust variance was used to estimate the prevalence of viral suppression (<200 copies/mL) before and after BUP initiation. We then matched individuals who initiated BUP with controls based upon viral load measurement dates and used prior event rate ratio (PERR) methods to estimate the effect of initiation of BUP on viral suppression. PERR methods account for unmeasured confounders. RESULTS We identified 279 PWH who initiated BUP. After BUP initiation, PWH were more likely to be virally suppressed (prevalence ratio [PR]: 1.19, 95% CI [1.03, 1.37],). After matching PWH initiating BUP to 2422 PWH controls and accounting for measured and unmeasured confounders, BUP initiation increased viral suppression for both those on ART at baseline (PERR PR: 1.08 [1.00, 1.18]) and those not on ART at baseline (PR: 1.31 [1.10, 1.61]). CONCLUSIONS Our results indicate that the initiation of BUP results in an increase in the probability of being virally suppressed after accounting for both measured and unmeasured confounders. Persons with opioid use disorder should initiate buprenorphine to not only treat substance use but also increase the chances of ART use for treatment as prevention.