Buprenorphine/Naloxone Treatment Decreases Opioid Use and HIV Risk Behaviors in China and Thailand

Buprenorphine/naloxone (BUP/NX) treatment for opioid use disorder has been shown to reduce injection risk behaviors, but access in Central/Southeast Asia remains limited. This open-label trial compared incident HIV infection and mortality rates among 1251 people with injection drug use in China and Thailand. Participants were randomized to receive either short-term treatment, in which they were initiated on BUP/NX and then tapered over up to 15 days—this was repeated if needed at week 26—or long-term treatment, in which participants received BUP/NX for 46 weeks and then underwent a taper over the subsequent 6 weeks. Both groups received drug counseling.

• The study was stopped early due to lower than expected HIV infection rates. It did not show any difference in a composite outcome of HIV infection or death between the two groups.
• High-risk injection use behaviors (e.g., sharing needles) decreased in both groups.
• At weeks 24 and 48, individuals in the long-term group were less likely to have opioid use according to urine drug test and self-report than individuals in the short-term group. This difference was no longer apparent at 78 and 104 weeks.
• Approximately half of the individuals in both groups reported opioid use at week 104.

Comments:

This study showed decreased HIV risk behaviors and opioid use during BUP/NX treatment; however, benefits diminished after tapering, consistent with recent US studies. This first trial of BUP/NX prescribed in China or Thailand raises questions about how to best expand capacity for such treatment in regions of the world such as Southeast Asia where injection drug use plays a dominant role in HIV transmission. Although adherence rates provide initial evidence that the intervention was feasible and acceptable to participants, additional studies of providers and key community stakeholders will be important next steps to expanded access. Additionally, the observed HIV seroconversion rate calls into question the feasibility of using this as the endpoint in future trials of opioid agonist treatment.

Jessica S. Merlin, MD, MBA

Reference:

Metzger DS, Donnell D, Celentano DD, et al. Expanding substance use treatment options for HIV prevention with buprenorphine naloxone: HIV Prevention Trials Network 058 (HPTN 058). J Acquir Immune Defic Syndr. 2015;68(5):554–561.