Treatment of opioid dependence and coinfection with HIV and hepatitis C virus in opioid-dependent patients: the importance of drug interactions between opioids and antiretroviral agents

Clin Infect Dis. 2005 Jul 1;41 Suppl 1:S89-95. doi: 10.1086/429503.

Abstract

The occurrence of human immunodeficiency virus (HIV) disease and hepatitis C is common in injection drug users, most of whom are opioid dependent. Methadone pharmacotherapy has been the most widely used treatment for opioid addiction in this population. Methadone has significant, adverse drug-drug interactions with many antiretroviral therapeutic agents that can contribute to nonadherence and poor clinical outcomes in this high-risk population. The present article summarizes current knowledge about interactions between methadone and antiretroviral medications. Buprenorphine is the newest agent available for the treatment of opioid dependence and may have fewer adverse interactions with antiretroviral agents. Buprenorphine has a significant pharmacokinetic interaction with efavirenz but no pharmacodynamic interaction; therefore, simultaneous administration of these drugs is not associated with opioid withdrawal, as has been observed with methadone. This promising finding may simplify the treatment of opioid-dependent patients with HIV disease and should also improve clinical outcomes for persons coinfected with HIV and hepatitis C virus.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Anti-Retroviral Agents / pharmacokinetics
  • Anti-Retroviral Agents / pharmacology*
  • Antiretroviral Therapy, Highly Active
  • Buprenorphine / pharmacokinetics
  • Buprenorphine / pharmacology
  • Drug Evaluation / trends
  • Drug Interactions
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Hepatitis C / complications*
  • Hepatitis C / drug therapy
  • Humans
  • Methadone / pharmacokinetics
  • Methadone / pharmacology
  • Narcotics / pharmacokinetics
  • Narcotics / pharmacology*
  • Protease Inhibitors / pharmacokinetics
  • Substance Abuse, Intravenous / complications*
  • Substance Abuse, Intravenous / therapy

Substances

  • Anti-Retroviral Agents
  • Narcotics
  • Protease Inhibitors
  • Buprenorphine
  • Methadone