New research presented at IAS 2023 included an 88% reduction in new HIV infections in Sydney, practice-changing results from the REPRIEVE trial, and more.

Starley Shade, PhD

Despite a high prevalence of chronic pain, treatment with opioids, and substance abuse among people with HIV, there is little clarity about the impact of an optimal response to stimulant use among people prescribed long-term opioid therapy (LTOT) for chronic, non-cancer pain. Starley Shade, PhD, and colleagues examined whether a urine drug test (UDT) positive for stimulants was associated with opioid-related harm or discontinuation of LTOT among patients with public insurance, matching 300 with HIV on LTOT to 300 without HIV on LTOT based on age, race/ethnicity, and sex; participants were followed from January to June 2019. In that time, 1,562 of 6,471 UDTs (24%) were positive for stimulants; however, 30 participants had 39% of the stimulant-positive UDTs. Dr. Shade and colleagues reported no statistically significant association between stimulant-positive UDTs and opioid-related ED visits or death within 90 days when accounting for repeat ED visits, with no difference based on HIV status. Stimulant-positive UDTs were associated with discontinuation of LTOT within 90 days (OR, 1.95; 95% CI, 1.68-2.27) and was more likely among Latin individuals (OR, 1.97; 95% CI, 1.08-3.60), and less likely among people with HIV (OR, 0.59; 95% CI, 0.44-0.79). While the association between stimulant-positive UDTs and opioid-related harm occurred among a minority of individuals on LTOT, stimulant-positive UDTs often resulted in LTOT discontinuation, and it is unclear whether less LTOT discontinuation among people with HIV who use stimulants is indicative of a more holistic approach among HIV clinicians, issues with opioid stewardship, or both, the researchers noted. Dr. Shade and colleagues suggested that instances of stimulant use should promote discussions about substance use and risk, rather than a reflex reaction to discontinue LTOT.