The medical management of opioid dependence in HIV primary care settings.
Injecting drug use is a common mode of transmission among persons with HIV/AIDS. Many HIV-infected patients meet diagnostic criteria for opioid dependence, a chronic and relapsing brain disorder. Most HIV providers, however, receive little training in substance use disorders. Opioid agonist therapy (OAT) has a stabilizing effect on opioid-dependent patients and is associated with greater acceptance of antiretroviral (ARV) therapy, higher ARV adherence, and greater engagement in HIV-related health care. Although methadone maintenance has been the OAT gold standard, methadone is available for the treatment of opioid dependence only in strictly regulated narcotic treatment programs. Buprenorphine, a partial opioid agonist approved for the office-based treatment of opioid dependence in 2002, may result in better health and substance use treatment outcomes for patients with HIV disease.
Lum
Paula J
PJ
Positive Health Program, Department of Medicine, University of California, San Francisco General Hospital, CA 94110, USA. plum@php.ucsf.edu
Tulsky
Jacqueline Peterson
JP
D019380:Anti-HIV Agents / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D011320:Primary Health Care; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy*
D019380:Anti-HIV Agents; D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone