Clinic-based treatment of opioid-dependent HIV-infected patients versus referral to an opioid treatment program: A randomized trial.
BACKGROUND
Opioid dependence is common in HIV clinics. Buprenorphine-naloxone (BUP) is an effective treatment of opioid dependence that may be used in routine medical settings.


OBJECTIVE
To compare clinic-based treatment with BUP (clinic-based BUP) with case management and referral to an opioid treatment program (referred treatment).


METHODS
Single-center, 12-month randomized trial. Participants and investigators were aware of treatment assignments. (ClinicalTrials.gov registration number: NCT00130819)


METHODS
HIV clinic in Baltimore, Maryland.


METHODS
93 HIV-infected, opioid-dependent participants who were not receiving opioid agonist therapy and were not dependent on alcohol or benzodiazepines.


METHODS
Clinic-based BUP included BUP induction and dose titration, urine drug testing, and individual counseling. Referred treatment included case management and referral to an opioid-treatment program.


METHODS
Initiation and long-term receipt of opioid agonist therapy, urine drug test results, visit attendance with primary HIV care providers, use of antiretroviral therapy, and changes in HIV RNA levels and CD4 cell counts.


RESULTS
The average estimated participation in opioid agonist therapy was 74% (95% CI, 61% to 84%) for clinic-based BUP and 41% (CI, 29% to 53%) for referred treatment (P < 0.001). Positive test results for opioids and cocaine were significantly less frequent in clinic-based BUP than in referred treatment, and study participants receiving clinic-based BUP attended significantly more HIV primary care visits than those receiving referred treatment. Use of antiretroviral therapy and changes in HIV RNA levels and CD4 cell counts did not differ between the 2 groups.


CONCLUSIONS
This was a small single-center study, follow-up was only moderate, and the study groups were unbalanced in terms of recent drug injections at baseline.


CONCLUSIONS
Management of HIV-infected, opioid-dependent patients with a clinic-based BUP strategy facilitates access to opioid agonist therapy and improves outcomes of substance abuse treatment.


BACKGROUND
Health Resources and Services Administration Special Projects of National Significance program.
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. glucas@jhmi.edu
Gregory M
GM
Lucas
Amina
A
Chaudhry
Jeffrey
J
Hsu
Tanita
T
Woodson
Bryan
B
Lau
Yngvild
Y
Olsen
Jeanne C
JC
Keruly
David A
DA
Fiellin
Ruth
R
Finkelstein
Patricia
P
Barditch-Crovo
Katie
K
Cook
Richard D
RD
Moore
D019380:Anti-HIV Agents / Q000627:therapeutic use; D015142:Baltimore; D002047:Buprenorphine / Q000627:therapeutic use*; D003153:Community Health Services / Q000592:standards*; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation; D016320:Substance Abuse Treatment Centers / Q000592:standards; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine