title: HIV risk reduction with buprenorphine-naloxone or methadone: findings from a randomized trial.
abstract: OBJECTIVE
  Compare HIV injecting and sex risk in patients being treated with methadone (MET) or buprenorphine-naloxone (BUP).
  
  
  METHODS
  Secondary analysis from a study of liver enzyme changes in patients randomized to MET or BUP who completed 24 weeks of treatment and had 4 or more blood draws. The initial 1:1 randomization was changed to 2:1 (BUP:MET) after 18 months due to higher dropout in BUP. The Risk Behavior Survey measured HIV risk before 30 days at baseline and weeks 12 and 24.
  
  
  RESULTS
  Among 529 patients randomized to MET, 391 (74%) were completers; among 740 randomized to BUP, 340 (46%) were completers; 700 completed the Risk Behavior Survey. There were significant reductions in injecting risk (P < 0.0008) with no differences between groups in mean number of times reported injecting heroin, speedball, other opiates, and number of injections; or percent who shared needles; did not clean shared needles with bleach; shared cookers; or engaged in front/back loading of syringes. The percent having multiple sex partners decreased equally in both groups (P < 0.03). For males on BUP, the sex risk composite increased; for males on MET, the sex risk decreased resulting in significant group differences over time (P < 0.03). For females, there was a significant reduction in sex risk (P < 0.02) with no group differences.
  
  
  CONCLUSIONS
  Among MET and BUP patients who remained in treatment, HIV injecting risk was equally and markedly reduced; however, MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but it increased for males on BUP and decreased for males on MET.
authors.affiliation: *Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Philadelphia, PA; †Department of Medicine, Yale University School of Medicine, New Haven, CT; ‡Department of Medicine, Oregon Health and Science University, Portland, OR; §Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA; ‖National Institute on Drug Abuse, Bethesda, MD; ¶Department of Psychiatry, University of California, San Francisco, San Francisco, CA; and #Department of Psychiatry, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
authors.forename: George E
authors.initials: GE
authors.lastname: Woody
authors.forename: Douglas
authors.initials: D
authors.lastname: Bruce
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Sumedha
authors.initials: S
authors.lastname: Chhatre
authors.forename: Sabrina
authors.initials: S
authors.lastname: Poole
authors.forename: Maureen
authors.initials: M
authors.lastname: Hillhouse
authors.forename: Petra
authors.initials: P
authors.lastname: Jacobs
authors.forename: James
authors.initials: J
authors.lastname: Sorensen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
authors.forename: David
authors.initials: D
authors.lastname: Metzger
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D040242:Risk Reduction Behavior; D015819:Substance Abuse, Intravenous / Q000517:prevention & control; D047568:Unsafe Sex / Q000706:statistics & numerical data
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone
references.citation: Health Aff (Millwood). 2013 Aug;32(8):1462-9
references.pmid: 23918492
references.citation: Arch Gen Psychiatry. 1978 Apr;35(4):501-16
references.pmid: 215096
references.citation: Drug Alcohol Depend. 1998 Mar 1;50(1):1-8
references.pmid: 9589267
references.citation: J Acquir Immune Defic Syndr (1988). 1993 Sep;6(9):1049-56
references.pmid: 8340896
references.citation: Drug Alcohol Depend. 2011 Jan 15;113(2-3):192-9
references.pmid: 20832196
references.citation: BMJ. 2010 Sep 16;341:c4851
references.pmid: 20847018
references.citation: Am J Psychiatry. 1993 Jan;150(1):53-8
references.pmid: 8417580
references.citation: J Health Soc Behav. 1988 Sep;29(3):214-26
references.pmid: 3241064
references.citation: JAMA. 2001 Oct 10;286(14):1724-31
references.pmid: 11594897
references.citation: Arch Intern Med. 1990 Jan;150(1):97-9
references.pmid: 2297301
references.citation: J Addict Dis. 1998;17(4):91-103
references.pmid: 9848034
references.citation: J Clin Psychopharmacol. 1996 Feb;16(1):58-67
references.pmid: 8834420
references.citation: Clin Pharmacol Ther. 1994 May;55(5):569-80
references.pmid: 8181201
references.citation: J Subst Abuse Treat. 2008 Jul;35(1):87-92
references.pmid: 17933486
references.citation: AIDS Care. 2002 Feb;14(1):77-93
references.pmid: 11798407
references.citation: J Subst Abuse Treat. 2006 Sep;31(2):187-94
references.pmid: 16919747
references.citation: Int J Addict. 1995 May;30(6):685-98
references.pmid: 7657397
references.citation: Drug Alcohol Depend. 2000 Apr 1;59(1):17-31
references.pmid: 10706972
references.citation: MMWR Morb Mortal Wkly Rep. 1984 Jul 13;33(27):377-9
references.pmid: 6330518
references.citation: Drug Alcohol Depend. 1996 Sep;42(1):11-20
references.pmid: 8889399
references.citation: Int J Addict. 1978 Feb;13(2):285-95
references.pmid: 640760
references.citation: Addiction. 2008 Sep;103(9):1484-92
references.pmid: 18636999
references.citation: J Clin Endocrinol Metab. 2005 Jan;90(1):203-6
references.pmid: 15483091
references.citation: J Subst Abuse Treat. 2008 Jun;34(4):391-7
references.pmid: 17869049
references.citation: JAMA. 1993 Apr 21;269(15):1953-9
references.pmid: 8385230
references.citation: AIDS Care. 1994;6(2):215-20
references.pmid: 8061081
references.citation: Drug Alcohol Depend. 2013 Feb 1;128(1-2):71-6
references.pmid: 22921476
references.citation: Clin Infect Dis. 2005 Sep 15;41(6):891-6
references.pmid: 16107991
references.citation: Int J Androl. 2009 Apr;32(2):131-9
references.pmid: 17971165
references.citation: J Subst Abuse Treat. 2003 Apr;24(3):233-9
references.pmid: 12810144
references.citation: Addiction. 2007 May;102(5):761-70
references.pmid: 17506153
references.citation: J Urban Health. 2000 Sep;77(3):331-45
references.pmid: 10976608
references.citation: Am J Psychiatry. 1999 Jan;156(1):27-33
references.pmid: 9892294
references.citation: Addiction. 2005 Feb;100(2):150-8
references.pmid: 15679744
references.citation: Public Health Rep. 1998 Jun;113 Suppl 1:107-15
references.pmid: 9722816
references.citation: J Gen Intern Med. 2006 Feb;21(2):193-5
references.pmid: 16336624
references.citation: J Acquir Immune Defic Syndr. 2001 Apr 15;26(5):483-9
references.pmid: 11391170
references.citation: Am J Drug Alcohol Abuse. 1977;4(1):13-20
references.pmid: 565588
references.citation: AIDS. 1994 Feb;8(2):223-31
references.pmid: 8043227
references.citation: JAMA. 1992 May 27;267(20):2750-5
references.pmid: 1578593