Search Results (3)

People who inject drugs (PWIDs) remain underserved in HIV care. Evidence on rapid antiretroviral therapy (ART) for PWID is limited. We evaluated feasibility, effectiveness, safety, and patient-reported outcomes (PROs) for rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) supported by a peer navigation in Greece. This is a single-arm, multicenter pilot study including PWIDs (≥18 years) newly diagnosed or relinking after >3 months off ART. Participants started BIC/FTC/TAF on the same day or within 7 days and received peer navigation for 48 weeks. Co-primary endpoints were Week-24 virologic suppression (HIV-1 RNA < 50 copies/mL; FDA Snapshot) and grade 3–4 adverse events (AEs). Secondary endpoints included complete-case suppression at Weeks 24/48, CD4 recovery, retention, and PROs. Outcomes were compared with historical controls from the same centers. Thirty-seven participants were enrolled (83.8% male; median age 33.3 years). Median time to ART was 0 days (vs 78 in controls, p < 0.001). Retention was 67.6% at Week 24 and 54.1% at Week 48. In the primary (FDA Snapshot) analysis, suppression was 62.2% and 54.1% at Weeks 24 and 48; in complete-case analyses, results were 92.0% and 100%, respectively. Mean CD4 count increased by 208 cells/μL (95% CI 141–275) at Week 48. Quality of life improved and symptom burden decreased. No grade 3–4 AEs occurred. Rapid BIC/FTC/TAF with peer navigation eliminated delays to ART and achieved favorable virologic, immunologic, and PROs among those retained, with good tolerability. Despite retention challenges, this model appears feasible for PWID and may help close HIV care gaps toward UNAIDS 95–95–95 targets. Full article

Background: Alcohol use disorder in the context of heroin addiction presents a significant challenge for clinicians, particularly in selecting the most appropriate pharmacological treatment. Methods: The present study aimed to retrospectively evaluate the efficacy of a six-month methadone maintenance (MM)/sodium oxybate (SMO) combination treatment in reducing ethanol intake among chronic alcohol-dependent patients with heroin use disorder (HUD). Specifically, we compared outcomes between those who continued SMO treatment after alcohol detoxification (MM/SMO-Maintained) and those who discontinued it (MM/SMO-Detoxified). Data were recruited using the ‘Pisa Addiction Database’ through a retrospective, naturalistic, cross-sectional comparative design involving a single patient assessment. Results: Our results indicate that treatment retention was higher in the MM/SMO-Maintained group. Conversely, discontinuing SMO treatment after alcohol detoxification was associated with a higher likelihood of dropout. At the endpoint, the MM/SMO-Maintained group showed significant improvement and was considered less severely ill. Conclusions: Long-term SMO treatment has proven to be well tolerated and effective in preventing relapse in individuals with both alcohol and HUD undergoing agonist opioid treatment. SMO may be considered the closest pharmacological option to substitution therapy for alcohol use disorder, and ongoing agonist opioid treatment should not preclude its co-administration. Full article

Modified opioid agonist therapy (OAT) guidelines that were initially introduced during the COVID-19 pandemic allow prescribers to increase the number of take-home doses to fulfill their need for physical distancing and prevent treatment discontinuation. It is crucial to evaluate the consequence of administering higher take-home doses of OAT on treatment retention and opioid-related harms among OAT recipients to decide whether the new recommendations should be retained post-pandemic. This study used an agent-based model to simulate individuals dispensed daily or weekly OAT (methadone or buprenorphine/naloxone) with a prescription over a six-month treatment period. Within the model simulation, a subset of OAT recipients was deemed eligible for receiving increased take-home doses of OAT at varying points during their treatment time course. Model results demonstrated that the earlier dispensing of increased take-home doses of OAT were effective in achieving a slightly higher treatment retention among OAT recipients. Extended take-home doses also increased opioid-related harms among buprenorphine/naloxone-treated individuals. The model results also illustrated that expanding naloxone availability within OAT patients’ networks could prevent these possible side effects. Therefore, policymakers may need to strike a balance between expanding access to OAT through longer-duration take-home doses and managing the potential risks associated with increased opioid-related harms. Full article