Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders

Authors

Alina Cernasev, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Sciences Center, Nashville, TN 37211, USA.
Michael P. Veve, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Sciences Center, Knoxville, TN 37920, USA.
Theodore J. Cory, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
Nathan A. Summers, Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
Madison Miller, Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
Sunitha Kodidela, Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
Santosh Kumar, Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN 38103, USA.

Abstract

The opioid epidemic has had a significant, negative impact in the United States, and people living with HIV/AIDS (PLWHA) represent a vulnerable sub-population that is at risk for negative sequela from prolonged opioid use or opioid use disorder (OUD). PLWHA are known to suffer from HIV-related pain and are commonly treated with opioids, leading to subsequent addictive disorders. PLWHA and OUD are at an increased risk for attrition in the HIV care continuum, including suboptimal HIV laboratory testing, delayed entry into HIV care, and initiation or adherence to antiretroviral therapy. Barriers to OUD treatment, such as medication-assisted therapy, are also apparent for PLWHA with OUD, particularly those living in rural areas. Additionally, PLWHA and OUD are at a high risk for serious drug-drug interactions through antiretroviral-opioid metabolic pathway-related inhibition/induction, or via the human ether-a-go-go-related gene potassium ion channel pathways. HIV-associated neurocognitive disorders can also be potentiated by the off-target inflammatory effects of opioid use. PLWHA and OUD might require more intensive, individualized protocols to sustain treatment for the underlying opioid addiction, as well as to provide proactive social support to aid in improving patient outcomes. Advancements in the understanding and management of PLWHA and OUD are needed to improve patient care. This review describes the effects of prescription and non-prescription opioid use in PLWHA.

Publication Title

Pharmacy (Basel, Switzerland)

Recommended Citation

Cernasev, A., Veve, M. P., Cory, T. J., Summers, N. A., Miller, M., Kodidela, S., & Kumar, S. (2020). Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders. Pharmacy (Basel, Switzerland), 8 (3) https://doi.org/10.3390/pharmacy8030168