The potential role of buprenorphine in the treatment of opioid dependence in HIV-infected individuals and in HIV infection prevention.
Untreated opioid dependence is a major obstacle to the successful treatment and prevention of human immunodeficiency virus (HIV) infection. In this review, we examine the interwoven epidemics of HIV infection and opioid dependence and the emerging role of buprenorphine in improving HIV treatment outcomes among infected individuals, as well as its role in primary and secondary prevention. This article addresses some of the emerging issues about integrating buprenorphine treatment into HIV clinical care settings and the various strategies that must be considered. Specifically, it addresses the role of buprenorphine in improving HIV treatment outcomes through engagement in care, access to antiretroviral therapy and preventive therapies for opportunistic infections, and the potential benefits of and pitfalls in integrating buprenorphine into HIV clinical care settings. We discuss the key research questions regarding buprenorphine in the area of improving HIV treatment outcomes and prevention, including a review of published studies of buprenorphine and antiretroviral treatment and currently ongoing studies, and provide insight into and models for integrating buprenorphine into HIV clinical care settings. Dialogue among practitioners and policy makers in the HIV care and substance abuse communities will facilitate an effective expansion of buprenorphine and ensure that these beneficial outcomes are achieved.
Altice
Frederick L
FL
AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA. frederick.altice@yale.edu
Sullivan
Lynn E
LE
Smith-Rohrberg
Duncan
D
Basu
Sanjay
S
Stancliff
Sharon
S
Eldred
Lois
L
D002047:Buprenorphine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015813:Substance Abuse Detection / Q000379:methods; D016320:Substance Abuse Treatment Centers; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D009292:Narcotic Antagonists; D002047:Buprenorphine