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.

The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review

“…Evidence from the treatment of opioid use disorders convincingly suggests that addiction treatment is effective for both primary [95] and secondary [69, 96] HIV prevention. The data for treating alcohol use disorders, however, is still emerging.…”

Medication-Assisted Treatment of Opioid Use Disorder

“…[53][54][55][56] In a secondary analysis using a large national cohort from a safety RCT (comparing hepatic responses to 24 weeks methadone and buprenorphine maintenance for OUD), 57 an interesting gender difference emerged: sexual risk behaviors increased among men maintained on buprenorphine but decreased in methadone-maintained men, whereas women decreased risk with either buprenorphine or methadone maintenance. [53][54][55][56] In a secondary analysis using a large national cohort from a safety RCT (comparing hepatic responses to 24 weeks methadone and buprenorphine maintenance for OUD), 57 an interesting gender difference emerged: sexual risk behaviors increased among men maintained on buprenorphine but decreased in methadone-maintained men, whereas women decreased risk with either buprenorphine or methadone maintenance.…”

Predictors of early dropout in outpatient buprenorphine/naloxone treatment

“…3, 4 In contrast, abstinence with continuous BN treatment approaches 50% at one year. 5, 6 Beyond promoting reductions in illicit opioid use, BN maintenance is associated with increases in quality of life, 7, 8 and reductions in mortality, 9, 10 HIV and hepatitis C risk behaviors, 9, 11 criminal activity, 12 and overall healthcare costs. 13 Treatment program retention among those receiving BN maintenance has also been associated with reduced risk of relapse, 14, 15 and lower likelihood of overdose.…”