Among People with Opioid Use Disorder, Buprenorphine and Methadone Treatment Lead to Decreases in Injection-Related HIV Risk

Methadone and buprenorphine treatment can reduce the risk of HIV infection among people with injection drug use but few studies have directly compared the efficacy of the two medications on injection and sexual risk. Researchers performed a secondary analysis of data from a 24-week randomized trial that assessed differences in hepatotoxicity between buprenorphine and methadone among 731 adults with opioid dependence. For this study, the HIV Risk Behavior Survey was used to assess participants’ injection and sexual risk behaviors to determine differences between those treated with methadone and those receiving buprenorphine. Randomization was 2:1 in favor of buprenorphine due to higher rates of dropout in that group.

• Injecting risk decreased with treatment in most ways measured, and did not differ between groups. The mean number of times a participant injected any substance in the last 30 days decreased from 74 at baseline to 6 at 24 weeks among participants receiving methadone, and from 70 to 6 among those treated with buprenorphine. High-risk injecting practices (e.g., sharing needles) also decreased. 
• Overall, sexual risk decreased slightly or stayed the same over time for both the methadone and buprenorphine groups. However, males receiving buprenorphine had a modest increase (41% to 47% at 24 weeks) in their sexual risk composite, whereas males receiving methadone had a small decrease in their sexual risk composite (46% to 44% at 24 weeks).

Comments:

This study suggests that both buprenorphine and methadone decrease HIV transmission risk primarily through decreased injection-related activities. Strategies to address sexual risk among patients treated with both medications are needed. Clinicians should screen for HIV transmission risk behaviors in their opioid-dependent patients and promote the use of methadone or buprenorphine among those at risk.

Jessica S. Merlin, MD, MBA

Reference:

Woody G, Bruce D, Korthuis PT, et al. HIV risk reduction with buprenorphine-naloxone or methadone: findings from a randomized trial. J Acquir Immune Defic Syndr. 2014;66(3):288–293.