HIV Infection and Depression Among Opiate Users in a US Epicenter of the Opioid Epidemic

Cecile M. Denis, Tiffany Dominique, Peter Smith, Danielle Fiore, Yi-Chien Ku, Angus Culhane, Debora Dunbar, Dana Brown, Menvekeh Daramay, Chelsea Voytek, Knashawn H. Morales, Michael B. Blank, Paul F. Crits-Christoph, Steven D. Douglas, Serguei Spitsin, Ian Frank, Krystal Colon-Rivera, Luis J. Montaner, David S. Metzger, Dwight L. Evans
AIDS Behav. 2021-01-15; 25(7): 2230-2239
DOI: 10.1007/s10461-020-03151-2

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Denis CM(1)(2), Dominique T(3), Smith P(3), Fiore D(3), Ku YC(3), Culhane A(3), Dunbar D(3), Brown D(3), Daramay M(3), Voytek C(3), Morales KH(4), Blank MB(3),
Crits-Christoph PF(3), Douglas SD(5), Spitsin S(5), Frank I(6), Colon-Rivera K(7), Montaner LJ(7), Metzger DS(3), Evans DL(3).

Author information:
(1)Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .
(2)Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Suite 4000, Philadelphia, PA, 19104-3309, USA.
.
(3)Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
(4)Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
(5)The Children’s Hospital of Philadelphia, Philadelphia, PA, USA.
(6)Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
(7)The Wistar Institute, Philadelphia, PA, USA.

Using a mobile research facility, we enrolled 141 opioid users from a neighborhood of Philadelphia, an urban epicenter of the opioid epidemic. Nearly all (95.6%) met DSM-5 criteria for severe opioid use disorder. The prevalence of HIV infection (8.5%) was more than seven times that found in the general population of the city. Eight of the HIV-positive participants (67.0%) reported receiving antiretroviral treatment but almost all of them had unsuppressed virus (87.5%). The majority of participants (57.4%) reported symptoms consistent with major depressive disorder. Severe economic distress (60.3%) and homelessness were common (57%). Polysubstance use was nearly universal, 72.1% had experienced multiple overdoses and prior medication for opioid use disorder (MOUD) treatment episodes (79.9%), but few currently engaged in addiction care. The prevalence, multiplicity and severity of chronic health and socioeconomic problems highlight consequences of the current opioid epidemic and underscore the urgent need to develop integrated models of treatment.