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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000165
Clinical Science

HIV Risk Reduction With Buprenorphine–Naloxone or Methadone: Findings From a Randomized Trial

Woody, George E. MD*; Bruce, Douglas MD; Korthuis, P. Todd MD; Chhatre, Sumedha PhD*; Poole, Sabrina MS*; Hillhouse, Maureen PhD§; Jacobs, Petra MD; Sorensen, James PhD; Saxon, Andrew J. MD#; Metzger, David PhD*; Ling, Walter MD§

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Abstract

Objectives: Compare HIV injecting and sex risk in patients being treated with methadone (MET) or buprenorphine–naloxone (BUP).

Methods: Secondary analysis from a study of liver enzyme changes in patients randomized to MET or BUP who completed 24 weeks of treatment and had 4 or more blood draws. The initial 1:1 randomization was changed to 2:1 (BUP:MET) after 18 months due to higher dropout in BUP. The Risk Behavior Survey measured HIV risk before 30 days at baseline and weeks 12 and 24.

Results: Among 529 patients randomized to MET, 391 (74%) were completers; among 740 randomized to BUP, 340 (46%) were completers; 700 completed the Risk Behavior Survey. There were significant reductions in injecting risk (P < 0.0008) with no differences between groups in mean number of times reported injecting heroin, speedball, other opiates, and number of injections; or percent who shared needles; did not clean shared needles with bleach; shared cookers; or engaged in front/back loading of syringes. The percent having multiple sex partners decreased equally in both groups (P < 0.03). For males on BUP, the sex risk composite increased; for males on MET, the sex risk decreased resulting in significant group differences over time (P < 0.03). For females, there was a significant reduction in sex risk (P < 0.02) with no group differences.

Conclusions: Among MET and BUP patients who remained in treatment, HIV injecting risk was equally and markedly reduced; however, MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but it increased for males on BUP and decreased for males on MET.

© 2014 by Lippincott Williams & Wilkins

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