Improved HIV and Substance Abuse Treatment Outcomes for Released HIV-Infected Prisoners: The Impact of Buprenorphine Treatment
Open Access
- 23 February 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Urban Health
- Vol. 87 (4), 592-602
- https://doi.org/10.1007/s11524-010-9438-4
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% log10 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.Keywords
This publication has 37 references indexed in Scilit:
- HIV/AIDS among Inmates of and Releasees from US Correctional Facilities, 2006: Declining Share of Epidemic but Persistent Public Health OpportunityPLOS ONE, 2009
- Accessing Antiretroviral Therapy Following Release From PrisonJAMA, 2009
- Treating Drug Abuse and Addiction in the Criminal Justice SystemJAMA, 2009
- A Study of Methadone Maintenance for Male PrisonersCriminal Justice and Behavior, 2007
- Interaction between buprenorphine and atazanavir or atazanavir/ritonavirDrug and Alcohol Dependence, 2007
- Antiretroviral Treatment Regimen Outcomes Among HIV-Infected PrisonersHIV Research & Clinical Practice, 2007
- Release from Prison — A High Risk of Death for Former InmatesNew England Journal of Medicine, 2007
- Behavioral Counseling Content for Optimizing the Use of Buprenorphine for Treatment of Opioid Dependence in Community-Based Settings: A Review of the Empirical EvidenceThe American Journal of Drug and Alcohol Abuse, 2007
- Effectiveness of Antiretroviral Therapy among HIV-Infected Prisoners: Reincarceration and the Lack of Sustained Benefit after Release to the CommunityClinical Infectious Diseases, 2004
- The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliabilityEuropean Psychiatry, 1997