buprenorphine and Acquired-Immunodeficiency-Syndrome

Global access to opioid agonist therapy and HIV/hepatitis C virus (HCV) treatment is expanding but when used concurrently, problematic pharmacokinetic and pharmacodynamic interactions may occur. Articles published from 1966 to 2012 in Medline were reviewed using the following keywords: HIV, AIDS, HIV therapy, HCV, HCV therapy, antiretroviral therapy, highly active antiretroviral therapy, drug interactions, methadone and buprenorphine. In addition, a review of abstracts from national and international meetings and conference proceedings was conducted; selected reports were reviewed as well. The metabolism of both opioid and antiretroviral therapies, description of their known interactions and clinical implications and management of these interactions were reviewed. Important pharmacokinetic and pharmacodynamic drug interactions affecting either methadone or HIV medications have been demonstrated within each class of antiretroviral agents. Drug interactions between methadone, buprenorphine and HIV medications are known and may have important clinical consequences. Clinicians must be alert to these interactions and have a basic knowledge regarding their management.

Topics: Acquired Immunodeficiency Syndrome; Analgesics, Opioid; Anti-Retroviral Agents; Buprenorphine; Drug Interactions; Hepatitis C; HIV Infections; Humans; Methadone; Opiate Substitution Treatment; Receptors, Opioid

Opioid dependence and HIV/AIDS are 2 of the most serious yet treatable diseases worldwide. Global access to opioid agonist therapy and HIV treatment is expanding but when concurrently used, problematic pharmacokinetic drug interactions can occur.. We reviewed English, Spanish, French, and Italian language articles from 1966 to 2005 in Medline using the following keywords: HIV, AIDS, HIV therapy, antiretroviral therapy, HAART, drug interactions, methadone, and buprenorphine. Additionally, we reviewed abstracts from national and international meetings and conference proceedings. Selected references from these articles were reviewed as well.. Clinical case series and carefully controlled pharmacokinetic interaction studies have been conducted between methadone and most approved antiretroviral therapies. Important pharmacokinetic drug interactions have been demonstrated within each class of agents, affecting either methadone or antiretroviral agents. Few studies, however, have been conducted with buprenorphine. The metabolism of both therapies, description of the known interactions, and clinical implications and management of these interactions are reviewed.. Certain interactions between methadone and antiretroviral medications are known and may have important clinical consequences. To optimize care, clinicians must be alert to these interactions and have a basic knowledge regarding their management.

Topics: Acquired Immunodeficiency Syndrome; Analgesics, Opioid; Anti-HIV Agents; Buprenorphine; Drug Interactions; HIV Infections; Humans; Methadone

Topics: Acquired Immunodeficiency Syndrome; Buprenorphine; Codeine; Female; Heroin Dependence; HIV Infections; HIV Seropositivity; HIV Seroprevalence; Humans; Incidence; Male; Methadone; Prospective Studies; Risk Factors; Self Medication; Sex Work; Sexual Behavior; Substance Abuse, Intravenous

This month's guest authors are affiliated with the substance abuse treatment and treatment research unit of the Connecticut Mental Health Center and the department of psychiatry at Yale University School of Medicine, where Dr. Rosen is instructor and Dr. Kosten is associate professor. They discuss a promising new treatment that may reduce abuse of cocaine by drug addicts who use intravenous heroin and may indirectly reduce risk-taking behavior associated with transmission of the human immunodeficiency virus.

Topics: Acquired Immunodeficiency Syndrome; Buprenorphine; Cocaine; Humans; Methadone; Opioid-Related Disorders; Risk Factors; Substance Abuse, Intravenous; Substance-Related Disorders

To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.. We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.. Muar, Malaysia.. 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.. Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.. Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.. Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

Topics: Acquired Immunodeficiency Syndrome; Buprenorphine; Cost-Benefit Analysis; Heroin Dependence; Humans; Malaysia; Naltrexone; Risk Factors; Risk-Taking; Treatment Outcome

Medication for opioid use disorder (MOUD) is an effective intervention to combat opioid use disorder and overdose, yet there is limited understanding of engagement in treatment over time in the community, contextualized by ongoing substance use. We aimed to identify concurrent trajectories of methadone prescriptions, buprenorphine prescriptions, and illicit opioid use among older adults with a history of injection drug use.. We used data on 887 participants from the AIDS Linked to the IntraVenous Experience cohort, who were engaged in the study in 2013 and attended ≥1 visit during follow-up (2014-2019). Outcomes were self-reported MOUD prescription and illicit opioid use in the last 6 months. To identify concurrent trajectories in all 3 outcomes, we used group-based multi-trajectory modeling. We examined participant characteristics, including sociodemographics, HIV status, and other substance use, overall and by cluster.. We identified 4 trajectory clusters: (1) no MOUD and no illicit opioid use (43%); (2) buprenorphine and some illicit opioid use (11%); (3) methadone and no illicit opioid use (28%); and (4) some methadone and illicit opioid use (18%). While prevalence of each outcome was stable across time, transitions on/off treatment or on/off illicit opioid use occurred, with the rate of transition varying by cluster. The rate of transition was highest in Cluster 3 (0.74/person-year) and lowest in Cluster 1 (0.18/person-year). We saw differences in participant characteristics by cluster, including that the buprenorphine cluster had the highest proportion of people with HIV and participants who identified as non-Hispanic Black.. Most participants had discontinued illicit opioid use and were also not accessing MOUD. Trajectories defined by engagement with buprenorphine or methadone had distinct sociodemographic and behavioral characteristics, indicating that tailored interventions to expand access to both types of treatment are likely needed to reduce harms associated with untreated opioid use disorder.

Topics: Acquired Immunodeficiency Syndrome; Aged; Analgesics, Opioid; Buprenorphine; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders

Multifactor neuropathic pain is one of the most frequent symptoms in AIDS patients and analgesic treatment is primarily based on the use of drug combination of opioids, tricyclic antidepressants and antiepileptics. However, the chronic use of opioids in AIDS patients presents a risk due to the immunosuppressive action of these drugs. Until now, buprenorphine has been regarded as one of the safest opioid analgesics for the treatment of patients with compromised immune systems. To assess the suitability of transdermal fentanyl for the treatment of neuropathic pain in AIDS patients, the present study compares the efficacy, tolerability and the immunosuppressive effects of transdermal buprenorphine vs. fentanyl.. Forty advanced AIDS patients (28 male and 12 female) with chronic peripheral neuropathic pain were enrolled onto this clinical trial. Neuropathic pain was assessed for its constituent types of pain (burning, stabbing and shooting), its overall intensity and allodynia; scores were awarded using the Neuropathic Pain Scale, expressed as 10 item VAS scores.. Both treatment groups showed statistically significant reductions in each of the individual types of neuropathic pain and allodynia (P<0.05; 95% CI: -14.7, -3.1) and significant improvements in Karnofsky Performance Status (P<0.05; mean value, 69; range: 40-90). Both buprenorphine and fentanyl were well tolerated. Neither buprenorphine nor fentanyl affected CD4+ or CD8+levels and both treatments, but particularly buprenorphine group, resulted in more stable CD4+ concentrations.. The high efficacy, tolerability and patient compliance of both buprenorphine and fentanyl make both these two opioids valid therapeutic options for the treatment of neuropathic pain in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Analgesics, Opioid; Buprenorphine; CD4-CD8 Ratio; Female; Fentanyl; Humans; Karnofsky Performance Status; Male; Middle Aged; Neuralgia; Pain Measurement; Patient Satisfaction; Transdermal Patch; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Analgesics, Opioid; Buprenorphine; Female; Fentanyl; Humans; Male; Neuralgia

Since 1994-1995, rapid development of widely available substitution treatments has appeared to be a major healthcare step in heroin addiction. Currently approximately 60000 patients are taking daily maintenance doses of oral methadone and about 7200 are taking sublingual buprenorphine. In parallel with the expansion of these treatments, the number of lethal overdoses has fallen off regularly: 564 in 1994, 393 in 1996 and 143 in 1998 (-74.6% in 4 years).. We searched for a correlation between the rise in the number of patients taking maintenance treatments and the decreased in recorded deaths due to heroin overdose. Other factors which may influence this decrease were also considered.. A linear correlation was found between the increasing number of patients on maintenance treatment (high-dose buprenorphine or methadone) and the decrease in fatal heroin overdoses in France between 1994 and 1998. The importance of this correlation must be modulated by the presence of other events such as political, social, healthcare and behavioral events concerning drug users.

Topics: Acquired Immunodeficiency Syndrome; Attitude to Health; Buprenorphine; Drug Overdose; Drug Prescriptions; Drug Utilization; Female; France; Health Knowledge, Attitudes, Practice; Heroin; Heroin Dependence; Humans; Linear Models; Male; Methadone; Mortality; Narcotics; Population Surveillance; Risk Factors

To measure pharmacists involvement in harm reduction programs and in delivery of maintenance therapies in order to estimate their contribution to the new public health policy.. A longitudinal study was conducted among 327 pharmacies located in the southern suburban area of Paris (28 communities) using a standardized questionnaire.. The response rate was 95% in 1996 and 92% in 2000. The number of condoms offered to intravenous drug users (IDU) decreased dramatically from 99% to 24% while delivered units decreased from 857 to 566 per day for needles and from 1200 to 760 per month per pharmacy for methylmorphine tablets (14.93 mg/tablet). Pharmacists delivered injecting equipment to some of their patients under opiate treatment: methylmorphine 19%, buprenorphine 35%, methadone 14%. Their contribution to the local healthcare network on addiction decreased from 38% to 20%. Nevertheless, the pharmacists attitude towards the IDU and public health policy was found to be improving with problems being mentioned for 62% of the cases in 1996 and for 16% in 2000.. Pharmacists are rapidly and intensively changing their practices and are discovering a new comprehensive relationship with IDU. Better pharmacist involvement is associated with a shift in local healthcare network concentration, reinforcing the general practitioner-pharmacist partnership.

Topics: Acquired Immunodeficiency Syndrome; Analgesics, Opioid; Attitude of Health Personnel; Buprenorphine; Condoms; Health Policy; Humans; Longitudinal Studies; Methadone; Needle-Exchange Programs; Pharmacists; Professional Role; Risk; Substance Abuse, Intravenous; Surveys and Questionnaires

Topics: Acquired Immunodeficiency Syndrome; Adult; Buprenorphine; France; HIV Infections; HIV Seropositivity; Humans; Mental Disorders; Methadone; Morphine; Paris; Substance-Related Disorders; Time Factors

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Buprenorphine; Emergencies; Heroin Dependence; HIV Infections; Hospitalization; Humans; Methadone; Morphine; Outpatients; Patient Care Team; Substance-Related Disorders