HIV Treatment Outcomes Among HIV-Infected, Opioid-Dependent Patients Receiving Buprenorphine/Naloxone Treatment within HIV Clinical Care Settings: Results From a Multisite Study

Abstract

Background Having opioid dependence and HIV infection are associated with poor HIV-related treatment outcomes. Methods HIV-infected, opioid-dependent subjects (N = 295) recruited from 10 clinical sites initiated buprenorphine/naloxone (BUP/NX) and were assessed at baseline and quarterly for 12 months. Primary outcomes included receiving antiretroviral therapy (ART), HIV-1 RNA suppression, and mean changes in CD4 lymphocyte count. Analyses were stratified for the 119 subjects not on ART at baseline. Generalized estimating equations were deployed to examine time-dependent correlates for each outcome. Results At baseline, subjects on ART (N = 176) were more likely than those not on ART (N = 119) to be older, heterosexual, have lower alcohol addiction severity scores, and lower HIV-1 RNA levels; they were less likely to be homeless and report sexual risk behaviors. Subjects initiating BUP/NX (N = 295) were significantly more likely to initiate or remain on ART and improve CD4 counts over time compared with baseline; however, these improvements were not significantly improved by longer retention on BUP/NX. Retention on BUP/NX for three or more quarters was, however, significantly associated with increased likelihood of initiating ART (β = 1.34 [1.18, 1.53]) and achieve viral suppression (β = 1.25 [1.10, 1.42]) for the 64 of 119 (54%) subjects not on ART at baseline compared with the 55 subjects not retained on BUP/NX. In longitudinal analyses, being on ART was positively associated with increasing time of observation from baseline and higher mental health quality of life scores (β = 1.25 [1.06, 1.46]) and negatively associated with being homo- or bisexual (β = 0.55 [0.35, 0.97]), homeless (β = 0.58 [0.34, 0.98]), and increasing levels of alcohol addiction severity (β = 0.17 [0.03, 0.88]). The strongest correlate of achieving viral suppression was being on ART (β = 10.27 [5.79, 18.23]). Female gender (β = 1.91 [1.07, 3.41]), Hispanic ethnicity (β = 2.82 [1.44, 5.49]), and increased general health quality of life (β = 1.02 [1.00,1.04]) were also independently correlated with viral suppression. Improvements in CD4 lymphocyte count were significantly associated with being on ART and increased over time. Conclusions Initiating BUP/NX in HIV clinical care settings is feasible and correlated with initiation of ART and improved CD4 lymphocyte counts. Longer retention on BPN/NX was not associated with improved prescription of ART, viral suppression, or CD4 lymphocyte counts for the overall sample in which the majority was already prescribed ART at baseline. Among those retained on BUP/NX, HIV treatment outcomes did not worsen and were sustained. Increasing time on BUP/NX, however, was especially important for improving HIV treatment outcomes for those not on ART at baseline, the group at highest risk for clinical deterioration. Retaining subjects on BUP/NX is an important goal for sustaining HIV treatment outcomes for those on ART and improving them for those who are not. Comorbid substance use disorders (especially al...

Emergency Department Use among HIV-Infected Released Jail Detainees

“…In the case for PLWHA in community settings, being retained on buprenorphine results in numerous improved HIV treatment outcomes, including ART receipt and virological suppression. 76 This proof-of-concept has been verified among prison-released PLWHA, 15,53 but not for jail detainees. Similarly, retention on buprenorphine in community-based cohorts is associated with a reduction in number of ED visits.…”

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

“…On the basis of clinical plausibility and available evidence [1,17,18,27,48,49], we selected several comorbidities that potentially could act as confounders in the associations between opioid abuse and dependence and postoperative events: AIDS and HIV infection, tobacco use, chronic anemia, alcohol abuse and dependence, depression, anxiety, and nonopioid drug abuse and dependence. The nonopioid drugs-illicit and prescription drugs used illicitly-considered were cannabis (ICD-9-CM codes 305.2x, 304.3x), hallucinogens (ICD-9-CM codes 305.3x, 304.5x), sedatives/hypnotics/anxiolytics (ICD-9-CM codes 305.4x, 304.1x), cocaine (ICD-9-CM codes 305.6x, 304.2x), amphetamines (ICD-9-CM codes 305.7x, 304.4x), antidepressants (ICD-9-CM code 305.8x), and other/unspecified substances (ICD-9-CM codes 305.9x, 304.6x, 304.8x, 304.9x) [33].…”

“…Using a large healthcare utilization database, we performed this study (1) to determine the prevalence of opioid abuse and dependence as a coded diagnosis in patients undergoing elective orthopaedic surgery; and (2) to characterize the relationship of opioid abuse and dependence with inpatient mortality and adverse events, failure to rescue, prolonged length of stay (LOS), and nonroutine disposition. In addition, we wanted (3) to document which patient and hospital characteristics and which orthopaedic procedures are more likely to be associated with high-risk opioid use.…”

Barreras para implementar el despistaje, intervenciones breves y referencia al tratamiento por problemas de consumo de alcohol y otras drogas en hospitales que atienden personas que viven con el VIH/SIDA en el Perú

“…El trastorno por uso de sustancias interfiere con el alcance de los resultados clínicos del tratamiento antirretroviral (TARGA), que incluye la falla en la recuperación del conteo de CD4 y en la supresión viral (1,2) . Asimismo, disminuye la adherencia al TARGA y reduce el uso de servicios de salud (1,(3)(4)(5) .…”