Clinic-Based Treatment of Opioid-Dependent HIV-Infected Patients Versus Referral to an Opioid Treatment Program A Randomized Trial
Clinic-Based Treatment of Opioid-Dependent HIV-Infected Patients Versus Referral to an Opioid Treatment Program A Randomized Trial
复制标题
DOI：
10.7326/0003-4819-152-11-201006010-00003
复制
发表时间：
2010-06-01
影响因子：
39.2
通讯作者：
Moore, Richard D.
中科院分区：
文献类型：
--
作者：
Lucas, Gregory M.;Chaudhry, Amina;Moore, Richard D.
背景：阿片类药物依赖在HIV诊所很常见。丁丙诺啡-纳洛酮（BUP）是一种有效的治疗阿片类药物依赖，可用于在常规的医疗setting.Objective：比较基于临床的治疗与BUP（基于临床的BUP）的情况下管理和转诊阿片类药物治疗程序（转诊治疗）。设计：单中心，12个月的随机试验。参与者和研究者都知道治疗分配。（ClinicalTrials.gov注册号：NCT 00130819）设置：巴尔的摩，马里兰州的HIV诊所。患者：93名HIV感染，阿片类药物依赖的参与者，他们没有接受阿片类药物激动剂治疗，也没有依赖酒精或苯二氮卓类药物。干预：基于临床的BUP包括BUP诱导和剂量滴定，尿液药物检测和个体咨询。转诊治疗包括病例管理和转诊至阿片类药物治疗项目。测量：阿片类药物激动剂治疗的开始和长期接受，尿液药物检测结果，与初级艾滋病毒护理提供者的访视出勤率，抗逆转录病毒治疗的使用，以及HIV RNA水平和CD 4细胞计数的变化。在基于临床的BUP中，阿片类激动剂治疗的平均估计参与率为74%（95% CI，61%至84%），在转诊治疗中为41%（CI，29%至53%）（P < 0.001）。阿片类药物和可卡因的阳性检测结果在基于诊所的BUP中的频率明显低于转诊治疗，接受基于诊所的BUP的研究参与者参加的艾滋病毒初级保健访问明显多于接受转诊治疗的患者。使用抗逆转录病毒治疗和HIV RNA水平和CD 4细胞计数的变化在两组之间没有差异。局限性：这是一项小型单中心研究，随访仅为中度，并且研究组在基线时最近的药物注射方面不平衡。艾滋病毒感染者的管理，阿片类药物依赖患者使用基于临床的BUP策略有助于获得阿片类药物激动剂治疗，并改善药物滥用治疗的结果。
Background: Opioid dependence is common in HIV clinics. Buprenorphine-naloxone (BUP) is an effective treatment of opioid dependence that may be used in routine medical settings.Objective: To compare clinic-based treatment with BUP (clinic-based BUP) with case management and referral to an opioid treatment program (referred treatment).Design: Single-center, 12-month randomized trial. Participants and investigators were aware of treatment assignments. (ClinicalTrials.gov registration number: NCT00130819)Setting: HIV clinic in Baltimore, Maryland.Patients: 93 HIV-infected, opioid-dependent participants who were not receiving opioid agonist therapy and were not dependent on alcohol or benzodiazepines.Intervention: Clinic-based BUP included BUP induction and dose titration, urine drug testing, and individual counseling. Referred treatment included case management and referral to an opioid-treatment program.Measurements: Initiation and long-term receipt of opioid agonist therapy, urine drug test results, visit attendance with primary HIV care providers, use of antiretroviral therapy, and changes in HIV RNA levels and CD4 cell counts.Results: The average estimated participation in opioid agonist therapy was 74% (95% CI, 61% to 84%) for clinic-based BUP and 41% (CI, 29% to 53%) for referred treatment (P < 0.001). Positive test results for opioids and cocaine were significantly less frequent in clinic-based BUP than in referred treatment, and study participants receiving clinic-based BUP attended significantly more HIV primary care visits than those receiving referred treatment. Use of antiretroviral therapy and changes in HIV RNA levels and CD4 cell counts did not differ between the 2 groups.Limitation: This was a small single-center study, follow-up was only moderate, and the study groups were unbalanced in terms of recent drug injections at baseline.Conclusion: Management of HIV-infected, opioid-dependent patients with a clinic-based BUP strategy facilitates access to opioid agonist therapy and improves outcomes of substance abuse treatment.