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Opioid Misuse Among HIV-Positive Adults in Medical Care

Results From the Medical Monitoring Project, 2009–2014

Lemons, Ansley, MPH*; DeGroote, Nicholas, MPH*; Peréz, Alejandro, MPH*; Craw, Jason, MPH*; Nyaku, Margaret, MPH*; Broz, Dita, PhD*; Mattson, Christine L., PhD; Beer, Linda, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1, 2019 - Volume 80 - Issue 2 - p 127–134
doi: 10.1097/QAI.0000000000001889

Background: People living with HIV are prescribed opioids more often and at higher doses than people who do not have HIV, and disproportionately experience risk factors for substance use disorder, which suggests they could be at increased risk of the misuse of opioids. Researchers also suggest that opioid misuse negatively affects various HIV clinical outcomes, increasing the risk of transmission to partners with an HIV-negative status.

Methods: We calculated weighted percentages and 95% confidence intervals to estimate substance use characteristics among a probability sample of 28,162 HIV-positive adults receiving medical care in the United States who misused opioids (n = 975). Then, we used Rao-Scott χ2 tests to assess bivariate associations between opioid misuse and selected characteristics.

Results: In all, 3.3% misused opioids. Misuse was more common among young adults, males, and non-Hispanic whites. Persons who misused opioids were less likely to: have been prescribed antiretroviral therapy (ART) (88.7%), report being adherent to ART medications in the past 3 days (78.1%), and have durable viral suppression (54.3%) than persons who did not misuse opioids (92.5%, 87.7%, and 64.7%, respectively). Persons who misused opioids were more likely to report condomless sex with partners of negative or unknown HIV status while not durably virally suppressed (11.7% vs 3.4%) than persons who did not misuse opioids.

Conclusions: Opioid misuse among adults receiving HIV medical care is associated with inadequate ART adherence, insufficient durable viral suppression, and higher risk of HIV transmission to sexual partners.

*Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and

Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence to: Ansley Lemons, MPH, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E46, Atlanta, GA 30329-4027 (e-mail:

Funding for the Medical Monitoring Project is provided by a cooperative agreement (PS09-937) from the Centers for Disease Control and Prevention.

Presented in part at the Conference on Retroviruses and Opportunistic Infections; March 4–7, 2018; Boston, Massachusetts.

The authors have no funding or conflicts of interest to disclose.

All authors contributed toward the conception of the analysis, interpretation of data, and revision and final approval of this manuscript. In addition, N.D. and A.P. contributed to data analysis, with the technical assistance of L.B., A.L., N.D., A.P., M.N., and J.C. drafted the manuscript. C.L.M. and D.B. contributed subject matter expertise on opioid misuse. L.B. served as the senior author, providing technical oversight for data analysis and interpretation. A.L. served as the lead and corresponding author, leading critical drafting and revisions, coordinating required CDC approvals, and being accountable for the approved final manuscript.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Received May 31, 2018

Accepted October 03, 2018

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