RISK OF OVERDOSE AND HIV DISEASE PROGRESSION IN OPIOID DEPENDENT INDIVIDUALS RECEIVING ANTIRETROVIRAL THERAPY AND PREVENTIVE NALTREXONE TREATMENT

Abstract



INTRODUCTION • Drug overdose is a common cause of non-AIDS death among people with HIV and the leading cause of death for people who inject drugs. • People who use drugs have a 74% greater risk of overdose if they are HIV-infected compared with their counterparts who are not HIV-infected. Risk factors for opioid overdose: • Opioid availability (both illicit and prescribed) • Combination of opioids and other psychoactive substances (especially alcohol and benzodiazepines) • Reduced tolerance due to a recent period of abstinence (particularly when enforced, such as in a period of incarceration) Risk factors for opioid overdose among people with HIV: • abnormal liver function or pulmonary problems • poor physical health • medical complications from injecting • reduction in CD4+ cell counts SPECIFIC AIM: to evaluate impact of HIV disease progression and naltrexone treatment on frequency of opioid overdoses among hiv infected people who inject drugs (PWID). METHODS We plan to enroll 400 HIV-positive opioid dependent patients who have completed one of two recent RCT: LINC (Linking Infectious and Narcology Care) and HAART (Adherence to HIV Therapy in Heroin Addicts: Oral vs. Extended Release Naltrexone). Patients characteristic LINC (n=200) HAART (n=200) ART 12 MOSHIV Yes Yes ART 12 MOS No Yes Naltrexone 12MOS No Yes Outcomes: The primary outcome is number of opioid overdoses (ASI scale). Independent variables are HIV disease progression (viral load, CD4 count), ART adherence, naltrexone adherence/ Study flow Significance: This study will evaluate whether HIV disease progression is a risk factor of opioid overdose among HIV infected PWID. Innovation: Simultaneous effect of HIV disease progression and naltrexone treatment on frequency of opioid overdoses among HIV infected is under-studied 112 МЕДИЦИНСКИЙ АКАДЕМИЧЕСКИЙ ЖУРНАЛ, 2016 г., ТОМ 16, № 3 ANALYSIS OF COMORBIDITIES IN HIV INFECTION V. V. Rassokhin, N. A. Belyakov, S. A. Buzunova Department of socially-significant infectious diseases First Pavlov State Medical University of St. Petersburg SPb Center AIDS, St. Petersburg, Russia Objectives. The aim of the study was to investigate the co-morbidity and metabolic changes in Russian HIV patients older than 40 years Methods. We conducted cross-Sectional study with analysis of medical records of 589 HIV-infected patients from different regions (St. Petersburg, Rostov, Novosibirsk). Inclusion criteria: age over 40 years, receiving HAART. We estimated metabolic parameters, 10-year risk of fatal cardiovascular disease (with use of SCORE scale), glomerular filtration rate, 10-year risk of fracture (FRAX). We perform bivariate analysis to indicate factors associated with co-morbidities and failed viral load suppression. Table 1. Characteristics of the patients Indicator Value Women (%) 46 Age (mean, years) 52 Men (%) 54 Age (mean, years) 51 Viral load <40 copies/ml (%) 81 Viral load >40 copies/ml (%) 19 CD4>350 cells/mcl, n (%) 64 CD4<350 cells/mcl, n (%) 36 Table 2. Treatment characteristics Indicator Value Duration of HAART (mean, years) 4,9 Used ARV NNRTl-43%, lP-48%, 11 (raltegravir)-9%, Fusion inhibitors (enfuvirtide) - 2%, CCR5 antagonist (maraviroc) - 0,1% Viral load <40 copies/ml (%) 81 Viral load >40 copies/ml (%) 19 CD4>350 cells/mcl, n (%) 64 CD4<350 cells/mcl, n (%) 36 Results. In the group of HIV-infected patients over 40 years high prevalence of cardiovascular diseases, metabolic disorders, diseases of the gastrointestinal tract was determined (Figure 1). In 20% there is a high (5-10%) and very high risk (>10%) of fatal cardiovascular disease within 10 years. Results of bivariate analysis Detectable viral load in patients on HAART were associated with less duration of HAART (mean 4.87 years vs. 5.9 years). Rate of detectable viral load in patients received non-nucleoside reverse-transcriptase inhibitors in scheme were 1.27 times that of patients received protease inhibitor and 3.37 times that of patients received integrase inhibitor (raltegravir). Compared to patients who did not take alcohol, there is a 1.78-fold increased risk of detectable viral load on HAART among patients, who take alcohol and 1.92-fold increased risk of arterial hypertension diagnosis (p<0.05). A high prevalence of patients (37%) regularly taking medications for correction of comorbidities in addition to HAART (Figure 2) makes drug interactions a highly actual problem. High prevalence of patients with high risk of fracture within 10 year (24%) makes osteoporosis a serious problem that reduces the ability to work and quality of life of people living with HIV (Figure 3). МЕДИЦИНСКИЙ АКАДЕМИЧЕСКИЙ ЖУРНАЛ, 2016 г., ТОМ 16, № 3 113 % 50 -, 45 40 35 30 25 201510 5 0 □ diseases of gastrointestinal tract EH diseases of the pulmonary system EH arterial hypertension И obesity / Metabolic Syndrome H family history of cardiovascular disease EH ischemic heart disease Ш diabetes EH tachycardia EH myocardial infarction El diseases of the skeletal system EH hepatitis С Ш hyperlipid emia ffl hepatitis В ЕШ diseases of the genitourinary system EH severe arterial hypertension ül tuberculosis S stroke Figure 1. Anamnesis history of HIV patients (N=589 patients) (Prevalence). 40 20 - % 37 27 16 15 1 0 D antihypertensive СИ choleretic H metabolics (mildronate) D vitamin B5 01 cholesterol absorption inhibitors 1 01 antiplatelet П fibrates □ statins (atorvastatin, fluvastatin) D anticoagulants (warfarin) D antiarrhythmics (propafenone) Figure 2. Prevalece of patients, receiving medications to riduce the risk of cardiovascular disease. CONCLUSION High coverage of HAART of patients with HIV at this stage does not mean control of HIV replication and immunosuppression. It is not enough to evaluate HIV RNA and CD4-lymphocytes in the assessing of HAART effectiveness. The health status of a patient, risk factors for the development of comorbidities should be taken into consideration. A high risk of cardiovascular disease and the presence of low bone mineral density in HIV-positive patients make it necessary to optimize HAART with the inclusion of modern, safe medications and appointment of additional measures of prevention and treatment. A high prevalence of smoking and alcohol abuse motivate physicians to work on improvement of the patient's lifestyle. □ Low (normal) (T-Score > -1,0) □ Medium (osteopenia) (-2,5<T-Score<-l) D High (osteoporosis) (T-Score< - 2,5)

V Palatkin

First Pavlov State Medical University of St.Petersburg

E Blokhina

First Pavlov State Medical University of St.Petersburg

T Yaroslavtseva

First Pavlov State Medical University of St.Petersburg

M Vetrova

First Pavlov State Medical University of St.Petersburg

E Zvartau

First Pavlov State Medical University of St.Petersburg

E M Krupitsky

First Pavlov State Medical University of St.Petersburg

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Copyright (c) 2016 Palatkin V., Blokhina E., Yaroslavtseva T., Vetrova M., Zvartau E., Krupitsky E.M.

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