Buprenorphine and its impact on depression symptoms among HIV-infected opioid-dependent patients: Results from the bhives collaboration
Method: We analyzed data from 303 HIV+ opioid dependent patients receiving buprenorphine treatment in a HRSA/SPNS project focused on integration of buprenorphine treatment into HIV care. Depression was assessed at baseline and quarterly for one year using the CES-D10; scores were analyzed as continuous and dichotomous values (above and below 10). History of psychiatric disorders, illicit drug use, HIV treatment, and availability of social support were included as predictors for the depression outcome.
Results: Most patients were over 40 (78%); unemployed (75%); HIV+ for ≥10 years (61%); and on antiretroviral therapy (60%). Depression scores decreased at one year compared to baseline (11.3 vs. 13.3, p=0.0008), as did the proportion of patients exhibiting depression symptoms (59.8% vs. 66.3%, p=0.028). In multivariate analysis, elevated scores were observed for females (p=0.0453), Latinos (p<0.0001) and homeless (p=0.0004) and those with psychiatric disorders (p=0.0006). Abstinence from heroin (p=0.0006) and other opioids (p=0.0443) were both associated with decreased depression. Being on antiretroviral therapy and having an undetectable viral load were only significant in bivariate analyses.
Discussion: Buprenorphine reduced depression among HIV+ opioid-dependent patients, although improvement was not consistent across populations. In addition, it is difficult to assess the significance of buprenorphine relative to other aspects of care. Findings suggest the need for further supports for vulnerable populations and additional research.
Learning Areas:Public health or related research
Describe the benefits of buprenorphine treatment on depression outcome in HIV+ opioid-dependent patients. Identify factors associated with differential depression outcomes in HIV+ patients undergoing buprenorphine treatment. Recognize the significance of integrated HIV, substance use and mental health services.
Keyword(s): Substance Abuse Treatment, Depression
Qualified on the content I am responsible for because: I am the principal research analyst/epidemiologist for the Buprenorphine-HIV Evaluation and Support Demonstration (BHIVES) Project and have been involved in a number of studies on buprenorphine treatment and many aspects of HIV+ substance abuse patients' health.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.