PT-012 - THE EFFECT OF BUPRENORPHINE VERSUS METHADONE TREATMENT ON NEUROCOGNITIVE IMPAIRMENT IN PERSONS WITH HIV AND OPIOID USE DISORDER.

E. Miller^1,2, A. Okpeku¹, C. Nnadi¹, J. Patterson³, M. McRae⁴; ¹VCU School of Pharmacy, Richmond, VA, United States, ²University of Virginia, Charlottesville, VA, United States, ³National Pharmaceutical Council, ⁴University of Virginia.

Background: Opioid use disorder (OUD) is estimated to be 2-4 times more common among persons with HIV compared to the national average. Treatment of OUD with opioid agonist therapy with buprenorphine or methadone, improves overall HIV outcomes. However, the impact of opioid agonist therapy on neurocognitive outcomes is less clear, especially among people with HIV. The goal of this study was to determine the impact of buprenorphine or
methadone treatment of OUD on neurocognitive outcomes in people with HIV.

Methods: This retrospective, longitudinal analysis utilized electronic health records from the TriNetX research network from 1999 to 2022. The study included adults with HIV (ICD-9/10 code: B20), that met the criteria for opioid dependence or abuse (ICD-9/10 codes: F11.1 or F11.2, respectively), and with at least two exposures to buprenorphine (RxNorm: 1819) or methadone (RxNorm: 6813). Multivariable logistic regression was used to compare the likelihood of a neurocognitive impairment diagnosis between those treated with buprenorphine vs. methadone, controlling for demographics, medical comorbidities, and concurrent medication use.

Results: Among 2270 patients, 1295 (57%) received buprenorphine. Multivariable analysis revealed that patients who received buprenorphine had 59% lower odds of developing neurocognitive impairment than those who received methadone (aOR: 0.41; 95% CI: 0.277, 0.596). Older age (aOR: 2.10; 95% CI:1.100, 4.009), hyperlipidemia (aOR: 1.65, 95% CI: 1.074, 2.522), diabetes mellitus (aOR: 1.58, 95% CI: 1.024, 2.447), depression (aOR: 1.78; 95% CI: 1.086, 2.909), use of an integrase inhibitor (aOR: 2.03; 95%, CI: 1.291, 3.177), and use of an antipsychotic medication (aOR: 1.68, 95% CI: 1.071, 2.629) increased the odds of neurocognitive impairment.

Conclusion: In a real-world analysis among people with HIV and OUD, buprenorphine was associated with a reduced risk of diagnosed neurocognitive impairment, even after adjusting for confounders. Additional prospective studies, as well as in vitro and in vivo analyses, are needed to further understand the relationship between treatments for OUD and neurocognitive impairment in people with HIV.