maintenance therapy and treatment with buprenorphine-naloxone are equally
effective at reducing HIV injecting risk behaviours among people who inject
drugs, investigators from the United States report in the online edition of the
Journal of Acquired Immune Deficiency
were associated with significant reductions in injecting practices linked to a risk of HIV transmission. Sexual
risk behaviour also decreased in women taking both therapies. However, drop-out
rates were higher among people treated with buprenorphine-naloxone and men
taking this therapy reported significantly higher rates of sexual risk-taking.
show marked and approximately equal reductions in injection and injection
related risk among participants who remained on their assigned treatment,” write
the authors. “Buprenorphine-naloxone, like methadone, is a successful HIV risk
reduction intervention for patients who remain in treatment, but with the added
advantage of being accessible in settings other than methadone programs in the
People who inject
drugs are one of the groups most affected by HIV in many countries including
the US. Methadone maintenance therapy has been shown to be an effective HIV
risk-reduction strategy for people who inject drugs. The treatment has been
associated with reduced opioid use, reduced needle sharing, reduced frequency of injecting and
lower HIV incidence and prevalence.
can also be used as opioid substitution therapy. A small study showed that
methadone maintenance therapy and buprenorphine-naloxone were equally effective
at reducing injecting risk behaviours, but that only methadone was associated with
consistent declines in sexual risk.
a larger study comparing the impact of methadone maintenance therapy and
buprenorphine-naloxone on injecting and sexual risk. Data were obtained from participants
enrolled in a study examining the effect of these two therapies on liver
Recruitment took place between May 2006 and October 2009 with follow-up until August 2010.
Participants were originally randomised on a 1:1 basis. However, a higher drop-out
rate among buprenorphine-naloxone recipients meant that this was changed to
2:1, buprenorphine to methadone.
completed the HIV Risk Behavior Survey at baseline and at weeks 12 and 24. The
survey included questions on injecting and sexual risk in the previous 30 days.
The total study
population consisted of 731 individuals (methadone= 391; buprenorphine = 340)
who completed the baseline risk survey. Of these, 96% completed the follow-up
surveys at weeks 12 and 24.
assessments showed that both therapies were associated with significant and
comparable reductions from baseline in the frequency of injecting (p <
0.0008 or greater). There were also significant reductions in the proportion of
participants who reported sharing injecting equipment, who did not clean their
equipment with bleach, who shared cookers, engaged in front/backloading and in
overall needle-associated risk (p < 0.0001). These reductions did not differ
by treatment assignment.
frequency of methamphetamine injecting increased among buprenorphine-naloxone
recipients (p < 0.05) but declined among those assigned to methadone maintenance therapy. The investigators were unable to explain this and suggest
it “may be an incidental finding as it has not been previously reported.”
groups reported a reduction in the number of sexual partners. Analysis of
sexual behaviour by gender showed that risk was reduced among women regardless
of their treatment assignment. For males, the sexual score increased for those
taking buprenorphine-naloxone but declined for those assigned to methadone
maintenance therapy. The authors suggest this “could be a result of a
greater impact on sexual hormone production among patients taking methadone,
their “findings further support the importance of expanding availability of
evidence-based medical treatment for opioid addiction.”
drop-out rate among patients treated with buprenorphine-naloxone “suggest that
methadone may be generally more effective.”