Opioid agonist treatment improves progression through the HIV cascade of care among people living with HIV who use unregulated opioids

Objectives: Opioid agonist treatment (OAT) has been shown to improve certain HIV-related treatment measures among people with HIV (PHIV) with opioid use disorder (OUD). However, there is limited data on the impacts of OAT along the whole HIV cascade of care. Design and Methods: Using data from an ongoing cohort of PHIV who use drugs in Vancouver, Canada, we used cumulative link mixed-effects models to estimate the independent effect of OAT on achieving progressive steps in the HIV cascade among participants using unregulated opioids daily, after adjusting for confounders. Results: Between 2005 and 2017, we recruited 639 PHIV regularly using opioids (median age 42 years, 59% male, 56% White), of whom 70% were on OAT at their baseline visit. Engagement in OAT showed a nonsignificant trend with higher linkage to HIV care (adjusted partial proportional odds ratio [APPO] = 1.75, 95% confidence interval [CI]: 0.83-3.69), and significantly higher cumulative odds of successfully achieving subsequent HIV cascade steps: on ART (APPO = 3.85, 95% CI: 2.33-6.37); adherent to ART (APPO = 3.15, 95% CI: 2.15-4.62); and HIV viral suppression (APPO = 2.18, 95% CI: 1.51-3.14). Conclusions: This study found a high level of OAT engagement among PHIV using unregulated opioids and that OAT engagement resulted in significantly increased progression through some of the higher steps of the HIV cascade. While these findings are encouraging, they highlight the need to reach populations off OAT to maximize the clinical and community-level benefits of ART.