Journal Article

A Trial of Integrated Buprenorphine/Naloxone and HIV Clinical Care

Lynn E. Sullivan, Declan Barry, Brent A. Moore, Marek C. Chawarski, Jeanette M. Tetrault, Michael V. Pantalon, Patrick G. O'Connor, Richard S. Schottenfeld and David A. Fiellin

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 43, issue Supplement_4, pages S184-S190
Published in print December 2006 | ISSN: 1058-4838
Published online December 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/508182
A Trial of Integrated Buprenorphine/Naloxone and HIV Clinical Care

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Background

Untreated opioid dependence adversely affects the care of human immunodeficiency virus (HIV)-positive patients. Buprenorphine, a partial opioid agonist, is available for maintenance treatment of opioid dependence in HIV specialty settings. We investigated the feasibility and efficacy of integrating buprenorphine, along with 2 levels of counseling, into HIV clinical care.

Methods

HIV-positive, opioid-dependent patients were enrolled in a 12-week pilot study and randomized to receive daily buprenorphine/naloxone treatment along with either brief physician management or physician management combined with nurse-administered drug counseling and adherence management. Primary outcomes included treatment retention; illicit drug use, assessed by urine toxicology test and self-report; CD4 lymphocyte counts; and log10 HIV type 1 (HIV-1) RNA levels.

Results

Of the 16 patients who received at least 1 dose of buprenorphine, 13 (81%) completed 12 weeks of treatment. The proportion of opioid-positive weekly urine test results decreased from 100% at baseline to 32% (month 1), 20% (month 2), and 16% (month 3). Only 4 patients reported any opioid use (in the prior 7 days) during the 12-week study. CD4 lymphocyte counts remained stable over the course of the study. The mean log10 HIV-1 RNA level (± standard deviation) declined significantly, from 3.66 ± 1.06 log10 HIV-1 RNA copies/mL at baseline to 3.0 ± 0.57 log10 HIV-1 RNA copies/mL at month 3 (P < .05). No significant differences based on counseling intervention were detected. All 13 patients who completed the study continued to receive treatment in an extension phase of at least 0–15 months' duration.

Conclusions

We conclude that it is feasible to integrate buprenorphine into HIV clinical care for the treatment of opioid dependence. Patients experienced good treatment retention and reductions in their opioid use. HIV biological markers remained stable or improved during buprenorphine/naloxone treatment.

Journal Article.  5062 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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