Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
AIDS Patient Care STDS. 2010 Jan;24(1):15-22. doi: 10.1089/apc.2009.0242.
Injection drug use (IDU) is an important vector of HIV infection in the United States. Many patients with HIV infection have comorbid substance use disorders. Integrated treatment for HIV and substance use disorders has been shown to improve HIV and other health outcomes, but significant barriers to integrated treatment exist. For individuals who are dependent on injection opioid drugs, agonist therapies of methadone or buprenorphine maintenance are available as part of a treatment program. Patients who are infected with HIV and require antiretroviral therapy (ART) are at risk for drug-drug interaction between ART and methadone or buprenorphine. We present a programmatic approach to the evaluation and treatment of opioid use disorders for HIV care providers, as well as a summary of the available knowledge of interactions of methadone and buprenorphine with ART, along with the level of evidence for each actual or potential interaction. Based on the available information of practice and the level of clinical significance of drug-drug interactions, we conclude that buprenorphine-based maintenance treatment for opioid dependent patients is the preferred maintenance therapy for integrated treatment systems.
注射吸毒（IDU）是美国 HIV 感染的一个重要途径。许多 HIV 感染者同时患有物质使用障碍。HIV 和物质使用障碍的综合治疗已被证明可以改善 HIV 和其他健康结果，但综合治疗存在重大障碍。对于依赖注射阿片类药物的个体，美沙酮或丁丙诺啡维持治疗的激动剂疗法可作为治疗计划的一部分。感染 HIV 并需要抗逆转录病毒治疗（ART）的患者面临 ART 与美沙酮或丁丙诺啡之间药物相互作用的风险。我们为 HIV 护理提供者提供了一种针对阿片类药物使用障碍的评估和治疗的方案方法，以及对美沙酮和丁丙诺啡与 ART 相互作用的现有知识的总结，以及每个实际或潜在相互作用的证据水平。基于现有信息和药物相互作用的临床意义水平，我们得出结论，丁丙诺啡为基础的维持治疗是阿片类药物依赖患者综合治疗系统的首选维持治疗。
