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

E. Jennifer Edelman, Tongtan Chantarat, Sarah Caffrey, Amina Chaudhry, Patrick G. O'Connor, Linda Weiss, David A. Fiellin, Lynn E. Fiellin

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)79-85
Number of pages7
JournalDrug and alcohol dependence
Volume139
DOIs
StatePublished - 2014
Externally publishedYes

Bibliographical note

Funding Information:
This work was generously supported by the Health Resources Services Agency and the Special Projects of National Significance (Grant No. H97HA03793) and the Robert Wood Johnson Foundation Clinical Scholars Program. Dr. L. Fiellin was a Robert Wood Johnson Physician Faculty Scholar during the conduct of this study. Dr. Edelman was funded as a Robert Wood Johnson Foundation, VA Clinical Scholar and Yale-Drug Abuse, Addiction, and HIV Research Scholar (1K12DA033312-01A1) during her involvement with this study. The funders had no further role in the study design, the collection, analysis and interpretation of data, in the writing, or the in the decision to submit the paper for publication.

Keywords

  • Buprenorphine
  • HIV
  • Opioid-related disorders
  • Risk behaviors

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