use of other illicit and legal drugs) in PWH can worsen neuroHIV (Anthony et al. 2005; Bell et al. 2006; Anthony et al. 2008) and cognitive impairment (Rodriguez Salgado et al. 2006; Martin-Thormeyer and Paul 2009; Byrd et al. 2011; Smith et al. 2014; Martin et al. 2018; Rubin et al. 2018) despite cART, even though some studies fail to show that opioids worsen neuroHIV (Royal et al. 1991; Applebaum et al. 2010) or HAND (Martin et al. 2019). Opiate exposure in cART-treated PWH worsens CD4 counts and viral loads (Ryan et al. 2004), neuropathol