Adherence to antiretroviral therapy in HIV-infected persons with opioid dependence receiving naltrexone treatment course
T. S. Yaroslavtseva,
A. N. Kholodnaia,
M. V. Vetrova,
E. A. Blokhina,
E. V. Verbitskaya,
E. E. Zvartau,
E. M. Krupitsky,
D. A. Lioznov https://doi.org/10.24884/1607-4181-2025-32-3-85-94
Abstract
Introduction. Optimal adherence to antiretroviral therapy (ART) is a key factor in achieving an undetectable HIV viral load (HIV VL). Among people with opioid use disorder (OUD), it is insufficient to suppress viremia. Treatment of OUD helps to increase the adherence and effectiveness of ART and HIV outcomes.
The objective was to evaluate the adherence to ART in patients with HIV and OUD treated with naltrexone in oral or implantable formulations, and to compare the data obtained using the Adherence Assessment Questionnaire (AAQ), Electronic Monitoring of Treatment (EMT), and dynamic of HIV VL.
Methods and materials. 200 patients with HIV infection (IV A-IV B) with OUD who completed a course of detoxification were divided into two groups (100 in each), where they received oral (ON) or implantable (IN) naltrexone treatment for 48 weeks simultaneously with ART. Outcomes of ART adherence: 1) adherence index (AI) (based on AAQ data); 2) EMT – the ratio of the number of actual openings to the number of openings to be made («correct openings»); 3) dynamic of the HIV VL level.
Results. ART adherence to AI and EMT is significantly higher in patients who completed treatment with naltrexone compared with those who discontinued the treatment earlier (92.4±15.17 vs. 89.32±21.33, p<0.001 and 73.3±22.0 % vs. 65.10±32.1 %, p=0.038, respectively). A significant correlation was found between AI and EMT (r=0.78, p=0.0001); and moderate for each method with the difference in HIV VL in dynamic (AI, r=0.306, p=0.0002; EMT, r=0.305, p=0.0002).
Conclusion. The stabilization of OUD remission helps to increase the ART adherence and improve the HIV outcomes. The results demonstrate the consistency of the objective and subjective methods for assessing ART adherence in patients with HIV and OUD.
About the Authors
T. S. Yaroslavtseva
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Yaroslavtseva Tatiana S., Research Fellow of the Laboratory of Clinical Pharmacology of Addiction Diseases, Psychopharmacology Department, Valdman Institute of Pharmacology
Competing Interests:
Authors declare no conflict of interest.
A. N. Kholodnaia
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Kholodnaia Anastasia N., Cand. of Sci. (Med.), Assistant of the Department of Infectious Diseases and Epidemiology
6-8, L’va Tolstogo str., Saint Petersburg, 197022
Competing Interests:
Authors declare no conflict of interest.
M. V. Vetrova
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Vetrova Marina V., Research Fellow of the Laboratory of Clinical Pharmacology of Addiction Diseases, Psychopharmacology Department, Valdman Institute of Pharmacology
6-8, L’va Tolstogo str., Saint Petersburg, 197022
Competing Interests:
Authors declare no conflict of interest.
E. A. Blokhina
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Blokhina Elena A., Dr. of Sci. (Med.), Head of the Laboratory of Clinical Pharmacology of Addiction Diseases, Psychopharmacology Department, Valdman Institute of Pharmacology
6-8, L’va Tolstogo str., Saint Petersburg, 197022
Competing Interests:
Authors declare no conflict of interest.
E. V. Verbitskaya
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Verbitskaya Elena V., Cand. of Sci. (Biol.), Associate Professor of the Department of Clinical Pharmacology and Evidence-based Medicine, Head of the Department of Biomedical Statistics
6-8, L’va Tolstogo str., Saint Petersburg, 197022
Competing Interests:
Authors declare no conflict of interest.
E. E. Zvartau
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Zvartau Edwin E., Dr. of Sci. (Med.), Professor, Head of the Department of Pharmacology
6-8, L’va Tolstogo str., Saint Petersburg, 197022
Competing Interests:
Authors declare no conflict of interest.
E. M. Krupitsky
Bekhterev National Medical Research Center for Psychiatry and Neurology; Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Krupitsky Evgeny M., Dr. of Sci. (Med.), Professor, Vice-Director for Research and Head of the Department of Addictology; Director of Valdman Institute of Pharmacology
6-8, L’va Tolstogo str., Saint Petersburg, 197022
3, Bekhtereva str., Saint Petersburg, 192019
Competing Interests:
Authors declare no conflict of interest.
D. A. Lioznov
Smorodintsev Research Institute of Influenza; Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Lioznov Dmitry A., Dr. of Sci. (Med.), Professor, Director; Head of the Department of Infectious Diseases and Epidemiology
6-8, L’va Tolstogo str., Saint Petersburg, 197022
15/17, Prof. Popova str., Saint Petersburg,197022
Competing Interests:
Authors declare no conflict of interest.
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Yaroslavtseva T.S., Kholodnaia A.N., Vetrova M.V., Blokhina E.A., Verbitskaya E.V., Zvartau E.E., Krupitsky E.M., Lioznov D.A. Adherence to antiretroviral therapy in HIV-infected persons with opioid dependence receiving naltrexone treatment course. The Scientific Notes of the Pavlov University. 2025;32(3):85-94. (In Russ.) https://doi.org/10.24884/1607-4181-2025-32-3-85-94
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