Case Presentation: Follow-up

The patient completed 12 weeks of ledipasvir/sofosbuvir. At 12 weeks after the end of treatment she achieved an SVR. Her CD4+ cell count is 560/µL and her HIV RNA is undetectable. She remains adherent to her HIV regimen. She has been taking 16 mg of buprenorphine and naloxone and her urine test results have been appropriately negative for opioids and other illicit drugs for more than 9 months. She feels well and reports that she has reengaged in her life and with her children and grandchildren.

Comment

Opioid use disorder is a chronic medical condition with a known neurobiologic basis. Stabilization of neurobiologic pathways through use of long-acting opioid agonist medications diminishes the risk of developing opioid withdrawal symptoms and blocks the effects of exogenous opioids. MOUD can effectively reduce opioid use and promote treatment retention. Although reduction in opioid use is often desired, perhaps the most important outcome is keeping patients retained in care to prevent excess morbidity and mortality.[20] Opioid agonist treatment should be individualized and should last for as long as is necessary to maintain clinical stability. Treatment of opioid use disorder in patients with HIV infection or HIV/HCV coinfection is feasible and improves adherence to treatment, HIV clinical parameters, and treatment retention. Colocation of treatment services for opioid use disorder and HIV infection or HIV/HCV coinfection (eg, including access to buprenorphine in a clinic that offers HIV and HCV clinical treatment services) is convenient and streamlines patient care. Models of colocated treatment services have proven effective and increase patient satisfaction.