EVALUATION OF TREATMENTS OF OPIOID DEPENDENCE IN HIV PATIENTS

该项目评估了药物和药物的安全性和有效性。 HIV感染患者阿片类药物依赖的行为治疗 在减少高危艾滋病毒传播行为的方法中 物质滥用者。艾滋病的流行已迅速蔓延到注射 吸毒者，其中许多人依赖阿片类药物；这些患者代表 对卫生保健系统的挑战，因为他们需要医疗保健和 因慢性疾病住院治疗。戒断综合征 表示可能会对结果产生负面影响的额外压力 对有危险的患者进行医疗治疗。我们目前正在进行 一项比较可乐定、美沙酮和美沙酮疗效的研究 丁丙诺啡用于阿片类药物短期戒毒及制定指南 用于阿片依赖患者的阿片类药物戒毒，住院治疗 与艾滋病相关的急性疾病。主客观衡量标准有 记录，包括戒断和疼痛变量。假设是 接受丁丙诺啡治疗的患者将表现出较低的戒断和疼痛 分数和更少的破坏性行为。这项研究是作为一项 口服可乐定的双盲、双模拟、随机试验 美沙酮和父母丁丙诺啡(简称阿片类药物) 解毒。 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)。 第三项研究将检验持续的艾滋病毒保护行为是否可以 通过增加认知-行为应对技能和复发来实现 对基于凭证的应急管理的预防干预。在一个 市内美沙酮维持可卡因的随机临床试验- 依赖科目，患者将学习自我控制技能：1) 增加非药物来源的强化与强化竞争 药物使用的影响；以及2)发展适应问题和注重问题的能力 以情绪为中心的应对反应，以管理药物的具体和一般生活 与吸毒和艾滋病毒风险传播有关的压力源。

This project assesses the safety and efficacy of pharmacological and behavioral treatments of opioid dependence in HIV-infected patients and in methods for decreasing high risk HIV transmission behaviors in substance abusers. 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. 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 acute AIDS-related illnesses. 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. A third study will examine whether sustained HIV protective behavior can be achieved by adding a cognitive-behavioral coping skills and relapse prevention intervention to voucher-based contingency management. In a randomized clinical trial with inner city methadone-maintained cocaine- dependent subjects, patients will be taught self-control skills: 1) to increase non-drug sources of reinforcement to compete with reinforcing effects of drug use; and 2) to develop adaptive problem-focused and emotion-focused coping responses to manage drug specific and general life stressors related to drug use and HIV risk transmission.