Buprenorphine and its impact on depression symptoms among HIV-infected opioid-dependent patients: Results from the bhives collaboration

Objective: Buprenorphine treatment has been associated with reduced depression among HIV negative opioid-dependent patients. This study assessed whether buprenorphine had a similar impact among HIV+ patients and factors associated with differential outcomes.

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.