EVALUATION OF TREATMENTS OF OPIOID DEPENDENCE IN HIV PATIENTS

这个项目评估了药物的安全性和有效性。 HIV感染患者阿片依赖的治疗。爱滋病 疫情迅速蔓延到注射吸毒者，其中许多人 依赖阿片类药物。这些患者代表着对健康的挑战 护理系统，因为他们需要医疗护理和住院治疗 医学上的障碍。 戒断综合症表现为额外的压力，可能会对 精神障碍患者的药物治疗结果。此外, 艾滋病患者可能会经历疼痛，例如由于外周疼痛 神经性疾病，可能会受到阿片类药物戒断的影响。阿片类药物 戒断可能会导致负面情绪状态(烦躁不安)和焦虑 这可能会诱导患者从事破坏性的行为，如吸毒 寻求、秘密使用非法药物，不适当的言语或身体上的 与医护人员发生冲突，或不遵守医疗规则 治疗，如提前出院治疗 建议。医生缺乏适当的行为和治疗指南 药物滥用的药理学管理。没有可控的 研究比较了不同戒毒治疗的结果 因内科疾病住院的患者，包括感染艾滋病毒的患者 病人。我们目前正在进行一项研究，以比较 可乐定、美沙酮和丁丙诺啡治疗短阿片类药物的疗效 戒毒和制定阿片类药物戒毒指南 阿片类药物依赖患者，因急性艾滋病住院 生病了。记录主观和客观测量，包括 戒断和疼痛变量。假设是患者接受了 丁丙诺啡表现出较低的戒断和疼痛评分 颠覆性行为。研究设计为双盲、双盲、双 口服可乐定、口服美沙酮和亲本的随机模拟试验 丁丙诺啡(IM)是阿片类药物短期戒毒的缩写。 阿片类药物可能会对免疫系统产生有害影响，并增强艾滋病毒 根据实验室的发现进行复制。流行病学研究， 然而，未能确认持续非法药物的有害影响 美沙酮的使用或维持对艾滋病毒疾病进展的影响。 美沙酮的维持似乎减少了艾滋病毒传播的危险行为 保护吸毒者免受艾滋病毒血清转换，并可能有助于遏制 艾滋病毒流行。我们正在评估美沙酮维持治疗对 HIV感染者的免疫功能(CD4、病毒载量)。

This project assesses the safety and efficacy of pharmacological treatments of opioid dependence in HIV-infected patients. The AIDS epidemic has rapidly extended to injection drug users, many of them dependent on opioids. These patients represent a challenge to the health care system, as they require medical care and hospitalization for chronic medical disorders. Withdrawal syndromes represent added stresses that may negatively affect the outcome of medical treatments in compromised patients. In addition, patients with AIDS may experience pain, such as that due to peripheral neuropathies, that may be affected by opioid withdrawal. Opioid withdrawal may result in negative mood states (dysphoria) and anxiety that may induce patients to engage in disruptive behaviors such as drug seeking, surreptitious illicit drug use, inappropriate verbal or physical confrontations with health care workers, or non-adherence to medical treatment, such as premature discharge from the hospital against medical advice. Physicians lack guidelines for appropriate behavioral and pharmacological management of substance abuse. There are no controlled studies comparing the outcome of different detoxification treatments in patients hospitalized for medical illnesses, including HIV-infected patients. We are currently conducting a study to compare the effectiveness of clonidine, methadone, and buprenorphine for short opioid detoxification and to develop guidelines for opioid detoxification in opioid-dependent patients, hospitalized for an acute AIDS related illness. Subjective and objective measures are recorded, including withdrawal and pain variables. The hypothesis is that patients receiving buprenorphine will show lower withdrawal and pain scores and fewer disruptive behaviors. The study is designed as a double blind, double dummy, randomized trial of oral clonidine, oral methadone and parental buprenorphine (IM) for short opioid detoxification. Opioids may have detrimental effects on the immune system and enhance HIV replication according to laboratory findings. Epidemiologic studies, however, fail to confirm a deleterious effect of continuous illicit drug use or of methadone maintenance on the progression of HIV diseases. Methadone maintenance appears to decrease HIV transmission risk behaviors which protect drug users from HIV seroconversion and may help contain the HIV epidemic. We are evaluating the effects of methadone maintenance on immune function (CD4, viral load) in HIV-infected drug users.