Improved HIV and substance abuse treatment outcomes for released HIV-infected prisoners: the impact of buprenorphine treatment.

Abstract

HIV-infected prisoners fare poorly after release. Though rarely available, opioid agonist therapy (OAT) may be one way to improve HIV and substance abuse treatment outcomes after release. Of the 69 HIV-infected prisoners enrolled in a randomized controlled trial of directly administered antiretroviral therapy, 48 (70%) met DSM-IV criteria for opioid dependence. Of these, 30 (62.5%) selected OAT, either as methadone (N = 7, 14.5%) or buprenorphine/naloxone (BPN/NLX; N = 23, 48.0%). Twelve-week HIV and substance abuse treatment outcomes are reported as a sub-study for those selecting BPN/NLX. Retention was high: 21 (91%) completed BPN/NLX induction and 17 (74%) remained on BPN/NLX after 12 weeks. Compared with baseline, the proportion with a non-detectable viral load (61% vs 63% log(10) copies/mL) and mean CD4 count (367 vs 344 cells/mL) was unchanged at 12 weeks. Opiate-negative urine testing remained 83% for the 21 who completed induction. Using means from 10-point Likert scales, opioid craving was reduced from 6.0 to 1.8 within 3 days of BPN/NLX induction and satisfaction remained high at 9.5 throughout the 12 weeks. Adverse events were few and mild. BPN/NLX therapy was acceptable, safe and effective for both HIV and opioid treatment outcomes among released HIV-infected prisoners. Future randomized controlled trials are needed to affirm its benefit in this highly vulnerable population.

• Authors: Sandra Ann Springer, Shu Chen, Frederick L Altice
• Journal: Journal of urban health : bulletin of the New York Academy of Medicine (J Urban Health) Vol. 87 Issue 4 Pg. 592-602 (Jul 2010) ISSN: 1468-2869 [Electronic] United States
• PMID: 20177974 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Anti-Retroviral Agents
• Buprenorphine, Naloxone Drug Combination
• Narcotic Antagonists
• Narcotics
• Naloxone
• Buprenorphine
• Methadone

Topics

• Anti-Retroviral Agents (therapeutic use)
• Buprenorphine (therapeutic use)
• Buprenorphine, Naloxone Drug Combination
• CD4 Lymphocyte Count
• Female
• HIV Infections (drug therapy)
• Humans
• Male
• Mental Disorders (complications)
• Methadone (therapeutic use)
• Middle Aged
• Naloxone (therapeutic use)
• Narcotic Antagonists (therapeutic use)
• Narcotics (therapeutic use)
• Prisoners
• Substance-Related Disorders (complications, drug therapy)