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Research Summary

Buprenorphine Treatment in an HIV Clinic Is Effective for Opioid Dependence but Does Not Improve HIV Outcomes

Providing office-based buprenorphine treatment in HIV clinics may improve both HIV and opioid-addiction outcomes. In this study, researchers randomly assigned 93 opioid-dependent HIV-infected adults attending an urban HIV clinic to either office-based buprenorphine (BUP) or referral to outside treatment. Subjects were followed for 12 months. Outcome measures included urine test results, participation in addiction treatment, visits with HIV care providers, CD4 cell counts, and HIV RNA levels.

  • Compared with subjects in the referral group, those in the BUP group
     
    • initiated opioid agonist treatment more rapidly;
    • were more likely to be in treatment over the 12 months of follow-up;
    • had fewer opioid- or cocaine-positive urine test results (44% versus 65% and 54% versus 76%, respectively); and
    • had more visits with their HIV care provider (median, 3.5 versus 3.0 visits).
  • There were no significant differences between the 2 groups in months of antiretroviral treatment, CD4 cell counts, HIV RNA levels, emergency department visits, or hospitalizations.

Comments:

This small study supports the feasibility and effectiveness of providing office-based buprenorphine in an HIV clinic but failed to show a benefit in terms of HIV outcomes. A greater impact might have been seen in areas where other opioid-addiction treatment options are not readily accessible. Moreover, in this study, BUP and HIV care were provided in the same setting but by separate providers; it is possible that having a single physician provide both services would improve outcomes further. Darius A. Rastegar, MD

Reference:

Lucas GM, Chaudhry A, Hsu J, et al. Clinic-based treatment of opioid-dependent HIV-infected patients versus referral to an opioid treatment program. Ann Intern Med. 2010;152(11):704–11.

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