Patients who have HIV/AIDS

Buprenorphine treatment can be effective among patients with HIV/AIDS who are already taking highly active antiretroviral therapy (HAART). In fact, it is convenient and preferred by many patients to receive both HIV and buprenorphine treatment from the same provider, which is not possible with methadone maintenance treatment.

Remember that buprenorphine is metabolized by cytochrome P450 3A4 enzyme, so there may be possible interactions with drugs such as protease inhibitors. Generally speaking, clinically significant drug interactions between HAART and buprenorphine are rare, as opposed to HAART interactions with methadone, which are often clinically significant and require methadone dosage adjustment.

Follow these guidelines for treating HIV/AIDS patients who are dependent on opioids and want to start on buprenorphine treatment:

  • Assess patients to ensure that they are well suited for buprenorphine treatment.
  • Monitor patients for adverse reactions such as opioid intoxication and withdrawal, since the use of certain HAART medications may affect buprenorphine concentration.

Follow these guidelines for treating HIV/AIDS patients who are maintained on buprenorphine and need to begin highly active antiretroviral therapy (HAART):

  • Maintain the patient's current dose of buprenorphine when starting HAART.
  • Educate patients about the signs of opioid intoxication and withdrawal and have them report any adverse events.
  • See patients more frequently during this transition period and be sure they have a contact number to reach someone who is knowledgeable about buprenorphine and HAART, in case of complications (and to avoid a relapse).


Related Resources: 
PCSS-B Guidance: Clinically Relevant Drug Interactions of Buprenorphine or Methadone with Other Frequently Prescribed Drugs
Description: 
Guideline document discussing interactions between buprenorphine and HIV medication.
Source: 
Physician Clinical Support System (PCSS)
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Medications Metabolized by Cytochrome P450
Description: 
List of drugs that interact with buprenorphine due to their metabolism by Cytochrome P450.
Source: 
Indiana University School of Medicine
4.333335
Your rating: None Average: 4.3 (3 votes)
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Buprenorphine and Primary HIV Care
Description: 
This report describes points of intersection between HIV and primary care treatment, and discusses how to integrate HIV care into primary medicine.
Source: 
The George Washington University School of Public Health and Health Services
4.75
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TIP 43. Chapter 10: Associated Medical Problems in Patients Who Are Opioid Addicted
Description: 
This chapter of TIP 43 is aimed to help treatment providers identify co-occurring medical problems in patients who are addicted to opioids.
Source: 
Substance Abuse and Mental Health Association (SAMHSA)
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Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians
Description: 
This survey of 375 physicians found that confidence addressing drug problems was positively associated with having a buprenorphine waiver.
Source: 
Journal of General Internal Medicine, 2007
4.5
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National Institute on Drug Abuse Research Report on HIV/AIDS
Description: 
This report by NIDA discusses the HIV/AIDS epidemic and how treating drug abuse is effective in preventing HIV.
Source: 
National Institute on Drug Abuse (NIDA)
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