HIV risk reduction with buprenorphine-naloxone or methadone: Findings from a randomized trial.
Research over the past 20 years has shown that methadone maintenance (MET) reduces opioid use and is an effective HIV risk reduction intervention. Like methadone, treatment with buprenorphine-naloxone (BUP) also appears to reduce HIV risk. To date, only one study has compared HIV risk in patients receiving MET versus BUP. This article reports on a similar comparison of a much larger samples in a secondary analysis of data from the National Drug Abuse Treatment Clinical Trials Network (CTN) protocol “Starting Treatment with Agonist Replacement Therapies (START).” START was a randomized, open-label phase 4 study in participants entering opioid agonist treatment programs throughout the country that aimed to compare the effect of BUP and MET on liver function. The Risk Behavior Survey (RBS) was administered to participants, measuring past 30-day HIV risk, at baseline and weeks 12 and 24.
Among the 529 patients randomized to MET, 391 (74%) were completers; among the 740 randomized to BUP, 340 (46%) were completers; 700 completed the RBS. There were significant reductions in injecting risk with no differences between groups in mean number of times reporting injecting heroin, speedball, other opiates, and number of injections. There were also no differences between groups in terms of 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. For males on BUP, the sex risk composite increased; for males on MET, the sex risk decreased, resulting in significant group differences over time. For females there was a significant reduction in sex risk 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 increased for males on BUP and decreased for males on MET. Overall, these findings further support the important of expanding availability of evidence-based medical treatments for opioid addiction.
Related protocols: CTN-0027