***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Having opioid dependence and HIV infection are associated with poor  HIV-related treatment outcomes . Methods : HIV-infected , opioid-dependent subjects ( N = 295 ) recruited from 10 clinical sites initiated  buprenorphine/naloxone ( BUP/NX )  and were assessed at baseline and quarterly for 12 months . Primary outcomes included receiving antiretroviral therapy ( ART ) , HIV-1 RNA suppression , and mean changes in CD4 lymphocyte count . Analyses were stratified for the 119 subjects not on ART at baseline . Generalized estimating equations were deployed to examine time-dependent correlates for each outcome . Results : At baseline , subjects on ART ( N = 176 ) were more likely than those not on ART ( N = 119 ) to be older , heterosexual , have lower alcohol addiction severity scores , and lower HIV-1 RNA levels ; they were less likely to be homeless and report sexual risk behaviors . Subjects initiating BUP/NX ( N = 295 ) were significantly more likely to initiate or remain on ART and improve CD4 counts over time compared with baseline ; however , these improvements were not significantly improved by longer retention on BUP/NX . Retention on BUP/NX for three or more quarters was , however , significantly associated with increased likelihood of initiating ART ( β = 1.34 [ 1.18 , 1.53 ] ) and achieve viral suppression ( β = 1.25 [ 1.10 , 1.42 ] ) for the 64 of 119 ( 54 % ) subjects not on ART at baseline compared with the 55 subjects not retained on BUP/NX . In longitudinal analyses , being on ART was positively associated with increasing time of observation from baseline and higher mental health quality of life scores ( β = 1.25 [ 1.06 , 1.46 ] ) and negatively associated with being homo- or bisexual ( β = 0.55 [ 0.35 , 0.97 ] ) , homeless ( β = 0.58 [ 0.34 , 0.98 ] ) , and increasing levels of alcohol addiction severity ( β = 0.17 [ 0.03 , 0.88 ] ) . The strongest correlate of achieving viral suppression was being on ART ( β = 10.27 [ 5.79 , 18.23 ] ) . Female gender ( β = 1.91 [ 1.07 , 3.41 ] ) , Hispanic ethnicity ( β = 2.82 [ 1.44 , 5.49 ] ) , and increased general health quality of life ( β = 1.02 [ 1.00,1.04 ] ) were also independently correlated with viral suppression . Improvements in CD4 lymphocyte count were significantly associated with being on ART and increased over time . Conclusions : Initiating BUP/NX in HIV clinical care setting s is feasible and correlated with initiation of ART and improved CD4 lymphocyte counts . Longer retention on BPN/NX was not associated with improved prescription of ART , viral suppression , or CD4 lymphocyte counts for the overall sample in which the majority was already prescribed ART at baseline . Among those retained on BUP/NX , HIV treatment outcomes did not worsen and were sustained . Increasing time on BUP/NX , however , was especially important for improving HIV treatment outcomes for those not on ART at baseline , the group at highest risk for clinical deterioration . Retaining subjects on BUP/NX is an important goal for sustaining HIV treatment outcomes for those on ART and improving them for those who are not . Comorbid substance use disorders ( especially alcohol ) , mental health problems , and quality -of-life indicators independently contributed to HIV treatment outcomes among HIV-infected persons with opioid dependence , suggesting the need for multidisciplinary treatment strategies for this population Background : The impact of antiretroviral therapy ( ART ) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown . Objective : To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART . Design and methods : A prospect i ve cohort study was performed in rural Ug and a. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling , voluntary counseling and testing ( VCT ) for cohabitating partners and condom provision . At baseline and follow-up , participants ’ HIV plasma viral load and partner-specific sexual behaviors were assessed . Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months . The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated , based on established viral load-specific transmission rates . Results : Six months after initiating ART , risky sexual behavior reduced by 70 % [ adjusted risk ratio , 0.3 ; 95 % confidence interval ( CI ) , 0.2–0.7 ; P = 0.0017 ] . Over 85 % of risky sexual acts occurred within married couples . At baseline , median viral load among those reporting risky sex was 122 500 copies/ml , and at follow-up , < 50 copies/ml . Estimated risk of HIV transmission from cohort members declined by 98 % , from 45.7 to 0.9 per 1000 person years . Conclusions : Providing ART , prevention counseling , and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ug and an adults during the first 6 months of therapy . Integrated ART and prevention programs may reduce HIV transmission in Africa We examined the impact of methadone maintenance therapy ( MMT ) on subsequent  antiretroviral therapy ( ART ) use in a prospect i ve cohort of injection drug users . At 24 months after enrolment , the rate of ART use was 69.7 % among those who were on MMT at baseline and 44.4 % among those not on MMT ( log-rank P = 0.001 ) . In a Cox model , the use of MMT was independently associated with an elevated rate of ART use Objective : To examine whether needle exchange program ( NEP ) use by injecting drug users ( IDUs ) affects injection risk behaviors over time . Methods : Between 1997 and 2000 , 901 IDUs in Chicago were recruited for a cohort study from a multisite NEP and an area with no NEP . Participants were interviewed and tested for HIV at baseline and 3 annual follow-ups . Non-NEP users received HIV prevention services consistent with the Indigenous Leader Outreach Model . R and om-effect logistic models were used to compare 5 injection-related risk behaviors between NEP users and nonusers . Results : The 30-day prevalence of receptive needle sharing decreased from 27.6 % at baseline to 10.0 % at visit 4 in NEP users and from 47.1 % to 20.0 % in nonusers . Similar patterns were observed for lending used needles , and NEP users were less likely to reuse their own needles . In multivariate analyses , NEP use was significantly associated with reduced odds of greater than 60 % for receptive needle sharing , 45 % for lending used needles , and 30 % for sharing other injection paraphernalia as well as approximately a 2-fold increase in the odds of always bleaching used needles . Conclusions : NEP use facilitates long-term reductions in injection risk practice s , and the reductions are in addition to the effects of a behavioral intervention alone Background : Though patients in opiate substitution programs are commonly infected with HCV , due to safety and efficacy concerns , they are rarely treated with interferon and ribavirin . Methods : In a multicenter study , HCV-infected patients in opiate maintenance treatment programs received 180 μg pegylated interferon-alfa-2a once weekly , plus daily ribavirin for 24 weeks ( genotypes 2 , 3 ) , or 48 weeks ( genotypes 1 , 4 ) . Results : Of the 67 patients enrolled , 31 ( 46 % ) had HCV genotypes 1 or 4 , and 36 ( 54 % ) had genotypes 2 or 3 . Intent-to-treat analysis showed end-of-treatment virologic response in 75 % of patients ( 81 % of genotypes 2 or 3 ; 65 % of genotypes 1 or 4 ) , and a sustained virologic response in 61 % of patients ( 72 % of genotypes 2 or 3 ; 48 % of genotypes 1 or 4 ) . Fifteen patients ( 22 % ) did not complete the study , in 5 ( 8 % ) cases because of severe adverse events . Conclusions : Drug users with chronic HCV infection , regularly attending an opiate maintenance program in which close collaboration between hepatologists/internists and addiction specialists is assured , can be treated effectively and safely  with pegylated interferon-alfa-2a and ribavirin . Treatment results are very similar to those in other patient groups , and thus therapy should also be considered for this population The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined . A 16-month prospect i ve study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services . The study group consisted of 212 seropositive and 264 seronegative drug injectors . A computerized medical encounter data base , with frequencies of primary care visits and with diagnoses for each visit , was linked to the cohort study data base that contained information on patients ' demographic characteristics , serologic status , and CD4 + T-lymphocyte counts . Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program . Those who were HIV-seropositive made more frequent visits than those who were seronegative ( mean annual visits 8.6 versus 4.1 , P < .001 ) , which increased with declining CD4 + T-lymphocyte counts ; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia , or both . Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia , tuberculosis , genitourinary infections , asthma , dermatologic disease , psychiatric illness , and complications of substance abuse ; those who were seronegative were most frequently seen for upper respiratory infection , psychiatric illness , complications of substance abuse , musculoskeletal disease , hypertension , asthma , and diabetes mellitus . Vaginitis and cervicitis , other gynecologic diseases , and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women BACKGROUND People who inject drugs ( PWID ) experience poor outcomes and fuel HIV epidemics in middle-income countries in Eastern Europe and Central Asia . We assess integrated/co-located ( ICL ) healthcare for HIV-infected PWID , which despite international recommendations , is neither widely available nor empirically examined . METHODS A 2010 cross-sectional study r and omly sample d 296 HIV-infected opioid-dependent PWID from two representative HIV-endemic regions in Ukraine where ICL , non-co-located ( NCL ) and harm reduction/outreach ( HRO ) setting s are available .  ICL setting s provide onsite HIV , addiction , and tuberculosis services , NCLs only treat addiction , and HROs provide counseling , needles/syringes , and referrals , but no opioid substitution therapy ( OST ) . The primary outcome was receipt of quality healthcare , measured using a quality healthcare indicator ( QHI ) composite score representing percentage of eight guidelines -based recommended indicators met for HIV , addiction and tuberculosis treatment . The secondary outcomes were individual QHIs and health-related quality -of-life ( HRQoL ) . RESULTS On average , ICL- participants had significantly higher QHI composite scores compared to NCL- and HRO- participants ( 71.9 % versus 54.8 % versus 37.0 % , p<0.001 ) even after controlling for potential confounders . Compared to NCL- participants , ICL- participants were significantly more likely to receive antiretroviral therapy ( 49.5 % versus 19.2 % , p<0.001 ) , especially if CD4 ≤ 200 ( 93.8 % versus 62.5 % p<0.05 ) ; guideline -recommended OST dosage ( 57.3 % versus 41.4 % , p<0.05 ) ; and isoniazid preventive therapy ( 42.3 % versus 11.2 % , p<0.001 ) . Subjects receiving OST had significantly higher HRQoL than those not receiving it ( p<0.001 ) ; however , HRQoL did not differ significantly between ICL- and NCL- participants . CONCLUSIONS These findings suggest that OST alone improves quality -of-life , while receiving care in integrated setting s collectively and individually improves healthcare quality indic 
    Output:
    
CONCLUSIONS Opioid agonist therapy is positively associated with ART initiation among HIV-positive people who inject drugs .