Retention on Buprenorphine Is Associated with High Levels of Maximal Viral Suppression among HIV-Infected Opioid Dependent Released Prisoners

Abstract

IntroductionHIV-infected prisoners lose viral suppression within the 12 weeks after release to the community. This prospective study evaluates the use of buprenorphine/naloxone (BPN/NLX) as a method to reduce relapse to opioid use and sustain viral suppression among released HIV-infected prisoners meeting criteria for opioid dependence (OD).MethodsFrom 2005–2010, 94 subjects meeting DSM-IV criteria for OD were recruited from a 24-week prospective trial of directly administered antiretroviral therapy (DAART) for released HIV-infected prisoners; 50 (53%) selected BPN/NLX and were eligible to receive it for 6 months; the remaining 44 (47%) selected no BPN/NLX therapy. Maximum viral suppression (MVS), defined as HIV-1 RNA<50 copies/mL, was compared for the BPN/NLX and non-BPN/NLX (N = 44) groups.ResultsThe two groups were similar, except the BPN/NLX group was significantly more likely to be Hispanic (56.0% v 20.4%), from Hartford (74.4% v 47.7%) and have higher mean global health quality of life indicator scores (54.18 v 51.40). MVS after 24 weeks of being released was statistically correlated with 24-week retention on BPN/NLX [AOR = 5.37 (1.15, 25.1)], having MVS at the time of prison-release [AOR = 10.5 (3.21, 34.1)] and negatively with being Black [AOR = 0.13 (0.03, 0.68)]. Receiving DAART or methadone did not correlate with MVS.ConclusionsIn recognition that OD is a chronic relapsing disease, strategies that initiate and retain HIV-infected prisoners with OD on BPN/NLX is an important strategy for improving HIV treatment outcomes as a community transition strategy.

Emergency Department Use among HIV-Infected Released Jail Detainees

“…In the case for PLWHA in community settings, being retained on buprenorphine results in numerous improved HIV treatment outcomes, including ART receipt and virological suppression. 76 This proof-of-concept has been verified among prison-released PLWHA, 15,53 but not for jail detainees. Similarly, retention on buprenorphine in community-based cohorts is associated with a reduction in number of ED visits.…”

“…Utilization of buprenorphine was defined by dates of buprenorphine prescription and follow-up voucher provision as previously described. 15,53 Among those meeting criteria for opioid dependence and therefore eligible for buprenorphine, participants were categorized as follows: (1) offered buprenorphine but either did not undergo induction or completed less than the full induction, or (2) retained on buprenorphine, defined as those who received at least one dose of buprenorphine beyond the 7-day induction period, including those with multiple re-inductions.…”

Opioid pharmacotherapy: Treatment, regimes, constructions and control

“…Also important is examination of the reduction within hospital of TB transmission, to compare with TB treatment outcomes for those whose TB is managed simultaneously through provision of MMT in community-based settings. Similar studies of HIV-infected opioid dependent prisoners who are transitioning to community affirm the benefit of buprenorphine treatment in improving HIV treatment outcomes (Springer, Qiu, Saber-Tehrani, & Altice, 2012). Also, integration of buprenorphine into HIV treatment settings improves a number of HIV treatment outcomes, including receipt of ART, improvements in CD4 and levels of viral suppression (Altice et al, 2011).…”

HIV/AIDS in prison: state of the art of scientific productions

“…It is suggested that this result is due to the fact that the use of treatment helped in controlling the craving for opiates after release from prison, allowing better adherence to treatment and consequently effective suppression of HIV replication possibilities. Note the therapy in this context as viral replication prevention tool and use of opioids after the arrest [4,20].…”

“…It is estimated that the number of people infected by the Human Immunodeficiency Virus (HIV) is higher among prisoners than in the general population, reaching epidemic proportions in some countries, the United States (1 in 100 behind bars), Malaysia (prevalence 10 times higher inside prisons) [3][4][5][6][7][8]. It is likely that, in some locations, like the federations belonging to the African continent, HIV infection rates differ from the real, because that homosexual activity is considered an illegal practice, masking the high incidence of the disease [9].…”