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Drug Alcohol Depend. 2014 Jun 1;139:79-85. doi: 10.1016/j.drugalcdep.2014.03.006. Epub 2014 Mar 15.

The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients.

Author information

  • 1Yale 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.
  • 2New York Academy of Medicine, 1216 5th Avenue, New York, NY 10029, United States.
  • 3Yale University School of Medicine, PO Box 208025, New Haven, CT 06520, United States.
  • 4Chase Brexton Health Care, 1111 North Charles Street, Baltimore, MD 21201, United States.
  • 5Yale 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.

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.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Buprenorphine; HIV; Opioid-related disorders; Risk behaviors

PMID:
24726429
[PubMed - indexed for MEDLINE]
PMCID:
PMC4029496
[Available on 2015-06-01]
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