Extended Study Follow-up Highlights Need for Improved Support for Engaging Those Who Inject Drugs Living With HIV in Treatment

Longer term data from an intervention focused on promoting antiretroviral treatment (ART) and medication for opioid use disorders (MOUD) among people who inject drugs (PWID) living with HIV are highlighting the complexity of targeting vulnerable populations at higher risk of contracting HIV and having uncontrolled infection.

Researchers have recently published additional findings from the HIV Prevention Trials Network (HPTN) 704 study, which assessed the impact of a flexible integrated intervention among more than 500 PWID living with HIV. In addition to facilitating engagement with and adherence to ART and MOUD, the intervention also included psychosocial counseling and check ins with system navigators.

After a year of follow up, the researchers found that compared with patients receiving standard of care, those receiving the intervention were significantly more likely to report ART use and MOUD. They were also significantly more likely to be virally suppressed, meaning that the amount of HIV in their body was so low that it was undetectable.

However, in their most recent findings, the researchers reported that after another year of the intervention, these improvements started to regress. Among the 111 patients who enrolled in the 1-year extension, viral suppression rates dropped from 41% to 29%. This coincided with declining ART and MOUD use. The researchers suggest that additional support may be needed to ensure continuous and potentially increased use of ART and MOUD and subsequent viral suppression.

“PWID face numerous barriers to HIV care and substance treatment at multiple levels, and barriers may change over time,” they wrote. “Delayed supplemental systems navigation boosters may help address newly developed barriers to HIV care and substance use treatment. Likewise, psychosocial counseling boosters may be warranted to leverage motivational interviewing, problem solving, skills building, and goal setting for maintaining ART and MOUD long-term.”

The researchers note that the anticipated emergence of long-acting injectables may also play a hand in increasing adherence to ART by removing the burden and stigma of daily pills. In January, the FDA approved ViiV Healthcare’s Cabenuva, the first monthly injectable treatment for HIV. Just recently, Gilead reported positive findings for their semiannual treatment lenacapavir in heavily pretreated patients who have stopped responding to other treatments.

While the study highlighted the need for additional supportive interventions to sustain improvements in treatment use and outcomes, it also suggested that the intervention can be reproduced and lead to improved outcomes among PWID based on findings from patients who originally received standard of care but then received the intervention in the extension portion of the study.

There were 94 patients receiving standard of care who enrolled in the extension part of the study and began receiving the intervention. These patients had increases in ART (55% to 69%) and MOUD (16% to 25%) use and rates of viral suppression (40% to 49%).