EVALUATION OF TREATMENTS OF DRUG DEPENDENCE IN HIV INFECTED PATIENTS

该项目评估了以下药物的安全性和有效性： 阿片类药物依赖的药物和行为治疗 艾滋病毒感染者和评估降低高风险的方法 药物滥用者的HIV传播行为。艾滋病 这种流行病迅速蔓延到注射吸毒者，其中许多人 依赖阿片类药物;这些患者代表了对 卫生保健系统，因为他们需要医疗和住院 治疗慢性疾病戒断综合征代表了 可能对医疗结果产生负面影响的额外压力 对受损患者进行治疗。在过去的一年里，我们完成了 一项随机、双盲临床试验， 三种阿片类药物解毒的效果 艾滋病患者的戒断症状和疼痛评分 急性疾病标准化和自我报告， 观察阿片类药物戒断的措施，疼痛面孔的选择， 疼痛和海洛因渴望视觉模拟量表 在四天的治疗期内收集。平均戒断时间 评分和平均疼痛评分从摄入到 治疗的第四天。无统计学显著 组间疗效差异。总体而言， 丁丙诺啡、可乐定和美沙酮对 治疗医学疾病患者的阿片类药物戒断。四十五 %的患者还接受了额外的吗啡。事后 分析，这些患者在治疗期间报告了更多的疼痛症状， 治疗，尽管摄入时疼痛评分较低。因此，在子集中， 的患者，阿片类药物解毒似乎会干扰疼痛 治疗第二项研究正在进行中， 持续的艾滋病毒保护行为可以通过增加 认知行为应对技能和预防复发 干预以凭证为基础的应急管理。中 市中心美沙酮维持的随机临床试验 可卡因依赖的科目，病人将被教导自我控制 技能：1）增加非药物强化源，以竞争 药物使用的强化作用; 2）发展适应性 以问题为中心和以情绪为中心的应对措施 与吸毒和艾滋病毒有关的特定毒品和一般生活压力因素 风险传递。

This project assesses the safety and efficacy of pharmacological and behavioral treatments of opioid dependence in HIV-infected patients and assesses 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. In the past year we completed a randomized, double-blind clinical trial to evaluate and compare the effects of three medications for opioid detoxification on withdrawal and pain scores in AIDS patients hospitalized for an acute medical condition. Standardized and self-reported and observed measures of opioid withdrawal, a choice of pain faces and visual analogue scales for pain and for desire/craving for heroin were collected over a four-day treatment period. Mean withdrawal scores and mean pain ratings decreased from intake and to the fourth day of treatment. There were no statistically significant differences in treatment efficacy between the groups. Overall, buprenorphine, clonidine, and methadone were equally effective for treating opioid withdrawal in medically ill patients. Forty-five percent of patients also received additional morphine. In post-hoc analysis, these patients reported more pain symptoms during treatment, in spite of lower pain scores at intake. Thus, in a subset of patients, opioid detoxification appeared to interfere with pain treatment. A second study is under way to 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.