The impact of cocaine use on outcomes in HIV-infected patients receiving buprenorphine/naloxone

Lynn E. Sullivan, Michael Botsko, Chinazo O. Cunningham, Patrick G. O'Connor, David Hersh, Jennifer Mitty, Paula J. Lum, Richard S. Schottenfeld, David A. Fiellin

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23 Scopus citations

Abstract

Background: Cocaine use is common in opioid-dependent HIV-infected patients, but its impact on treatment outcomes in these patients receiving buprenorphine/naloxone is not known. Methods: We conducted a prospective study in 299 patients receiving buprenorphine/naloxone who provided baseline cocaine data and a subset of 266 patients who remained in treatment for greater than or equal to one quarter. Assessments were conducted at baseline and quarterly for 1 year. We evaluated the association between baseline and in-treatment cocaine use on buprenorphine/naloxone retention, illicit opioid use, antiretroviral adherence, CD4 counts, HIV RNA, and risk behaviors. Results: Sixty-six percent (197 of 299) of patients reported baseline cocaine use and 65% (173 of 266) of patients with follow-up data reported in-treatment cocaine use. Baseline and in-treatment cocaine use did not impact buprenorphine/naloxone retention, antiretroviral adherence, CD4 lymphocytes, or HIV risk behaviors. However, baseline cocaine use was associated with a 14.8 (95% confidence interval [CI], 9.0-24.2) times greater likelihood of subsequent cocaine use (95% CI, 9.0-24.2), a 1.4 (95% CI, 1.02-2.00) times greater likelihood of subsequent opioid use, and higher log10 HIV RNA (P < 0.016) over time. In-treatment cocaine use was associated with a 1.4 (95% CI, 1.01-2.00) times greater likelihood of concurrent opioid use. Conclusions: Given cocaine use negatively impacts opioid and HIV treatment outcomes, interventions to address cocaine use in HIV-infected patients receiving buprenorphine/naloxone treatment are warranted.

Original languageEnglish (US)
Pages (from-to)S54-S61
JournalJournal of Acquired Immune Deficiency Syndromes
Volume56
Issue numberSUPPL. 1
DOIs
StatePublished - Mar 1 2011
Externally publishedYes

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Keywords

  • HIV
  • buprenorphine
  • cocaine
  • heroin dependence
  • opioid-related disorders

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Sullivan, L. E., Botsko, M., Cunningham, C. O., O'Connor, P. G., Hersh, D., Mitty, J., Lum, P. J., Schottenfeld, R. S., & Fiellin, D. A. (2011). The impact of cocaine use on outcomes in HIV-infected patients receiving buprenorphine/naloxone. Journal of Acquired Immune Deficiency Syndromes, 56(SUPPL. 1), S54-S61. https://doi.org/10.1097/QAI.0b013e3182097576