title: Buprenorphine for human immunodeficiency virus/hepatitis C virus-coinfected patients: does it serve as a bridge to hepatitis C virus therapy?
abstract: OBJECTIVE
  Buprenorphine is associated with enhanced human immunodeficiency virus (HIV) treatment outcomes including increased antiretroviral therapy initiation rates, adherence, and CD4 cell counts among HIV-infected opioid-dependent individuals. Buprenorphine facilitates hepatitis C virus (HCV) treatment in opioid-dependent patients with HCV monoinfection. Less is known about buprenorphine's role in HIV/HCV coinfection.
  
  
  METHODS
  We conducted a retrospective chart review to evaluate HCV care for HIV-infected buprenorphine patients in the first 4 years of buprenorphine's integration into a Rhode Island HIV clinic.
  
  
  RESULTS
  Sixty-one patients initiated buprenorphine. All had HCV antibody testing; 57 (93%) were antibody-positive. All antibody-positive patients underwent HCV RNA testing; 48 (84%) were RNA-positive. Of these, 15 (31%) were not referred to HCV care. Among chronically infected patients, 3 received HCV treatment after buprenorphine; all had cirrhosis and none achieved viral eradication. At buprenorphine induction, most patients had inadequately controlled HIV infection, with detectable HIV RNA (59%) or CD4 cell count less than or equal to 350/μL (38%).
  
  
  CONCLUSIONS
  Buprenorphine has shown limited success to date as a bridge to HCV treatment within an HIV clinic. Buprenorphine's stabilization of opioid dependence and HIV disease may permit the use of HCV therapy over time.
authors.affiliation: The Warren Alpert Medical School of Brown University/Miriam Hospital, 164 Summit Avenue, Center for AIDS Research Building Room 156, Providence, RI 02906, USA. LTaylor@Lifespan.org
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Taylor
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Maynard
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Macleod
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Rich
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Flanigan
authors.forename: Diana L
authors.initials: DL
authors.lastname: Sylvestre
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002047:Buprenorphine / Q000009:adverse effects / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D015658:HIV Infections / Q000453:epidemiology* / Q000534:rehabilitation*; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000009:adverse effects / Q000627:therapeutic use*; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control
chemical_list: D000998:Antiviral Agents; D000069479:Buprenorphine, Naloxone Drug Combination; D004338:Drug Combinations; D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine