Years of Heroin Use Predicts Abstinence in HIV-Infected Patients Receiving Buprenorphine

Background: Integration of buprenorphine treatment of opioid dependence into HIV care settings provides an opportunity to expand treatment access and improve outcomes. However, little is known about which HIV+ patients are most likely to benefit from this new mode of care. Methods: We analyzed data on 124 HIV+ opioid dependent patients who received office-based buprenorphine treatment in a HRSA/SPNS project studying integration of buprenorphine treatment into HIV care (BHIVES). Data included self-reported socio-demographics, general health measures, and substance use. We compared heroin use (HU) at baseline and after 90-days of treatment. Reported years of HU at baseline was recoded into 4 groups (≤5, 6-10, 11-20, or >20 years). Bivariate and multivariate analyses focused on years of HU as a predictor of HU in previous 30-days. Results: Most patients were over 40 years old (77%); unemployed (75%); and HIV+ for ≥10 years (59%). Prior month HU decreased at 90-days compared to baseline (39% vs. 75%, p<.001). In multivariate analysis, those who had used heroin for ≤5 years had greater odds of reporting past month heroin abstinence at 90-days (OR=12.6, p=.014) compared to those who had used heroin for >20 years. Gender, ethnicity, and age were not associated with self-reported HU at 90-days. Discussion: Buprenorphine treatment provided in HIV care settings results in reduced HU. Patients with a shorter history of opioid dependence are more likely to report abstinence at 90-days. Additional supports may be necessary for patients with longer HU histories.