title: The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients.
abstract: BACKGROUND
  Opioid dependence is a major risk factor for HIV infection, however, the impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected opioid-dependent patients is unknown.
  
  
  METHODS
  We conducted a longitudinal analysis of 303 HIV-infected opioid-dependent patients initiating buprenorphine/naloxone treatment. Outcomes included self-reported past 90-day needle-sharing and non-condom use. We assessed trends over the 12 months using the Cochran-Armitage trend test. Using generalized estimating equations, after multiple imputation, we determined factors independently associated with needle-sharing and non-condom use, including time-updated variables. We then conducted a mediation analysis to determine whether substance use explained the relationship between time since treatment initiation and needle-sharing.
  
  
  RESULTS
  Needle-sharing decreased from baseline to the fourth quarter following initiation of buprenorphine/naloxone (9% vs. 3%, p<0.001), while non-condom use did not (23% vs. 21%, p=0.10). HIV risk behaviors did not vary based on the presence of a detectable HIV-1 RNA viral load. Patients who were homeless and used heroin, cocaine/amphetamines or marijuana were more likely to report needle-sharing. Heroin use fully mediated the relationship between time since treatment initiation and needle-sharing. Women, patients who identified as being gay/lesbian/bisexual, those married or living with a partner and who reported heroin or alcohol use were more likely to report non-condom use. Older patients were less likely to report non-condom use.
  
  
  CONCLUSIONS
  While buprenorphine/naloxone is associated with decreased needle-sharing among HIV-infected opioid-dependent patients, sexual risk behaviors persist regardless of viral load. Targeted interventions to address HIV risk behaviors among HIV-infected opioid-dependent populations receiving buprenorphine/naloxone are needed.
authors.affiliation: Yale University School of Medicine, PO Box 208025, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States. Electronic address: ejennifer.edelman@yale.edu.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.affiliation: New York Academy of Medicine, 1216 5th Avenue, New York, NY 10029, United States.
authors.forename: Tongtan
authors.initials: T
authors.lastname: Chantarat
authors.affiliation: Yale University School of Medicine, PO Box 208025, New Haven, CT 06520, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Caffrey
authors.affiliation: Chase Brexton Health Care, 1111 North Charles Street, Baltimore, MD 21201, United States.
authors.forename: Amina
authors.initials: A
authors.lastname: Chaudhry
authors.affiliation: Yale University School of Medicine, PO Box 208025, New Haven, CT 06520, United States.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'Connor
authors.affiliation: New York Academy of Medicine, 1216 5th Avenue, New York, NY 10029, United States.
authors.forename: Linda
authors.initials: L
authors.lastname: Weiss
authors.affiliation: Yale University School of Medicine, PO Box 208025, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.affiliation: Yale University School of Medicine, PO Box 208025, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Fiellin
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D016485:Needle Sharing / Q000706:statistics & numerical data*; D058850:Opiate Substitution Treatment / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology; D012309:Risk-Taking; D047568:Unsafe Sex / Q000706:statistics & numerical data*
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine
keywords: Buprenorphine; HIV; Opioid-related disorders; Risk behaviors
references.citation: Alcohol Clin Exp Res. 2005 Jul;29(7):1190-7
references.pmid: 16046874
references.citation: J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S33-8
references.pmid: 21317592
references.citation: J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S7-13
references.pmid: 21317598
references.citation: J Subst Abuse Treat. 2009 Sep;37(2):138-50
references.pmid: 19150206
references.citation: J Acquir Immune Defic Syndr (1988). 1993 Sep;6(9):1049-56
references.pmid: 8340896
references.citation: J Addict Med. 2013 Mar-Apr;7(2):102-7
references.pmid: 23388678
references.citation: AIDS Behav. 2003 Dec;7(4):383-93
references.pmid: 14707535
references.citation: J Int AIDS Soc. 2012 Feb 23;15(1):10
references.pmid: 22360788
references.citation: Addict Behav. 2004 Aug;29(6):1189-97
references.pmid: 15236822
references.citation: AIDS. 2007 Jan 11;21(2):231-5
references.pmid: 17197815
references.citation: J Psychoactive Drugs. 2012 Jul-Aug;44(3):237-42
references.pmid: 23061323
references.citation: AIDS Behav. 2007 Mar;11(2):205-15
references.pmid: 16897350
references.citation: Cochrane Database Syst Rev. 2011 Aug 10;(8):CD004145
references.pmid: 21833948
references.citation: J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S22-32
references.pmid: 21317590
references.citation: J Assoc Nurses AIDS Care. 2010 Mar-Apr;21(2):144-52
references.pmid: 19879778
references.citation: J Acquir Immune Defic Syndr. 2010 Dec;55 Suppl 2:S84-7
references.pmid: 21406993
references.citation: Ann Behav Med. 2002 Summer;24(3):229-35
references.pmid: 12173680
references.citation: Drug Alcohol Depend. 2007 Nov;91 Suppl 1:S56-63
references.pmid: 17329041
references.citation: J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S14-21
references.pmid: 21317589
references.citation: Stat Med. 2007 Mar 15;26(6):1368-82
references.pmid: 16810713
references.citation: J Acquir Immune Defic Syndr. 2010 Dec;55 Suppl 1:S23-6
references.pmid: 21045595
references.citation: Lancet. 2008 Nov 15;372(9651):1733-45
references.pmid: 18817968
references.citation: BMJ. 2012 Oct 03;345:e5945
references.pmid: 23038795
references.citation: Stroke. 1999 Jan;30(1):34-9
references.pmid: 9880385
references.citation: Addiction. 2010 Jan;105(1):100-8
references.pmid: 20078464
references.citation: J Pers Soc Psychol. 1986 Dec;51(6):1173-82
references.pmid: 3806354
references.citation: AIDS Behav. 2008 Jul;12(4):662-9
references.pmid: 17487577
references.citation: AIDS Behav. 2011 Oct;15(7):1309-18
references.pmid: 19449099
references.citation: Source Code Biol Med. 2008 Dec 16;3:17
references.pmid: 19087314
references.citation: AIDS Behav. 2013 Nov;17(9):2902-13
references.pmid: 23835735
references.citation: Ann Intern Med. 2008 May 6;148(9):662-70
references.pmid: 18458279
references.citation: AIDS Behav. 2011 Jan;15(1):103-13
references.pmid: 19936912
references.citation: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD002207
references.pmid: 18425880
references.citation: J Acquir Immune Defic Syndr. 2008 Dec 1;49(4):451-5
references.pmid: 19186357
references.citation: AIDS. 2012 Nov 28;26(18):2383-91
references.pmid: 23079804
references.citation: Psychol Med. 1983 Aug;13(3):595-605
references.pmid: 6622612
references.citation: J Addict Med. 2013 Nov-Dec;7(6):410-6
references.pmid: 24189173
references.citation: Drug Alcohol Depend. 2013 Sep 1;132(1-2):74-80
references.pmid: 23410616
references.citation: Lancet. 2010 Mar 20;375(9719):1014-28
references.pmid: 20189638
references.citation: Am J Epidemiol. 1989 Jan;129(1):125-37
references.pmid: 2910056
references.citation: Hum Psychopharmacol. 2013 Sep;28(5):506-15
references.pmid: 24014144
references.citation: Curr HIV/AIDS Rep. 2010 May;7(2):99-106
references.pmid: 20425564
references.citation: J Nerv Ment Dis. 1985 Jul;173(7):412-23
references.pmid: 4009158
references.citation: J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S39-45
references.pmid: 21317593
references.citation: J Subst Abuse Treat. 2008 Jul;35(1):87-92
references.pmid: 17933486