***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 Data regarding the efficacy of directly administered antiretroviral therapy ( DAART ) are mixed . Opioid treatment programs ( OTPs ) provide a convenient framework for DAART . In a r and omized controlled trial , we compared DAART and self-administered therapy ( SAT ) among HIV-infected subjects attending five OTPs in Baltimore , MD . Methods HIV-infected individuals attending OTPs were eligible if they were not taking antiretroviral therapy ( ART ) or were virologically failing ART at last clinical assessment . In subjects assigned to DAART , we observed one ART dose per weekday at the OTP for up to 12 months . SAT subjects administered ART at home . The primary efficacy comparison was the between-arm difference in the average proportions with HIV RNA < 50 copies/mL during the intervention phase ( 3- , 6- , and 12-month study visits ) , using a logistic regression model accounting for intra-person correlation due to repeated observations . Adherence was measured with electronic monitors in both arms . Results We r and omized 55 and 52 subjects from five Baltimore OTPs to DAART and SAT , respectively . The average proportions with HIV RNA < 50 copies/mL during the intervention phase were 0.51 in DAART and 0.40 in SAT ( difference 0.11 , 95 % CI : −0.020 to 0.24 ) . There were no significant differences between arms in electronically-measured adherence , average CD4 cell increase from baseline , average change in log10 HIV RNA from baseline , opportunistic conditions , hospitalizations , mortality , or the development of new drug resistance mutations . Conclusions In this r and omized trial , we found little evidence that DAART provided clinical benefits compared to SAT among HIV-infected subjects attending OTPs . Trial Registration Clinical Trails.gov NCT00279110 NCT00279110?term = NCT00279110&rank = BACKGROUND AND AIMS HIV-infected people with substance use disorders are least likely to benefit from advances in HIV treatment . Integration of extended-release naltrexone ( XR-NTX ) into HIV clinics may increase engagement in the HIV care continuum by decreasing substance use . We aim ed to compare ( 1 ) XR-NTX treatment initiation , ( 2 ) retention and ( 3 ) safety of XR-NTX versus treatment as usual ( TAU ) for treating opioid use disorder ( OUD ) and /or alcohol use disorder ( AUD ) in HIV clinics . DESIGN Non-blinded r and omized trial of XR-NTX versus pharmacotherapy TAU . SETTING HIV primary care clinics in Vancouver , BC , Canada and Chicago , IL , USA . PARTICIPANTS Fifty-one HIV-infected patients seeking treatment for OUD ( n = 16 ) , AUD ( n = 27 ) or both OUD and AUD ( n = 8) . MEASUREMENTS Primary outcomes were  XR-NTX initiation ( receipt of first injection within 4 weeks of r and omization ) and retention at 16 weeks . Secondary outcomes generated point estimates for change in substance use , HIV viral suppression [ HIV RNA polymerase chain reaction ( pcr ) < 200 copies/ml ] and safety . FINDINGS Two-thirds ( 68 % ) of participants assigned to XR-NTX initiated treatment , and 88 % of these were retained on XR-NTX at 16 weeks . In comparison , 96 % of TAU participants initiated treatment , but only 50 % were retained on medication at 16 weeks . Mean days of opioid use in past 30 days decreased from 17.3 to 4.1 for TAU and from 20.3 to 7.7 for XR-NTX . Mean heavy drinking days decreased from 15.6 to 5.7 for TAU and 12.5 to 2.8 for XR-NTX . Among those with OUD , HIV suppression improved from 67 to 80 % for XR-NTX and 58 to 75 % for TAU . XR-NTX was well tolerated , with no precipitated withdrawals and one serious injection-site reaction . CONCLUSIONS Extended-release naltrexone ( XR-NTX ) is feasible and safe for treatment of opioid use disorder and alcohol use disorder in HIV clinics . Treatment initiation appears to be lower and retention greater for XR-NTX compared with treatment as usual ( clinical trials.gov NCT01908062 ) 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 : Opioid dependence and HIV infection are associated with poor health-related quality of life ( HRQOL ) .  Buprenorphine/naloxone ( bup/nx ) provided in HIV care setting s may improve HRQOL . Methods : We surveyed 289 HIV-infected opioid-dependent persons treated with clinic-based bup/nx about HRQOL  using the Short Form Health Survey ( SF-12 ) administered at baseline , 3 , 6 , 9 , and 12 months . We used normalized SF-12 scores , which correspond to a mean HRQOL of 50 for the general US population ( SD 10 , possible range 0 - 100 ) . We compared mean normalized mental and physical composite and component scores in quarters 1 , 2 , 3 , and 4 with baseline scores using generalized estimating equation models . We assessed the effect of clinic-based bup/nx prescription on HRQOL composite scores using mixed effects regression with site as r and om effect and time as repeated effect . Results : Baseline normalized SF-12 scores were lower than the general US population for all HRQOL domains . Average composite mental HRQOL improved from 38.3 ( SE 12.5 ) to 43.4 ( SE 13.2 ) [ β 1.13 ( 95 % CI : 0.72 to 1.54 ) ] and composite physical HRQOL remained unchanged [ β 0.21 ( 95 % CI : −0.16 to 0.57 ) ] over 12 months follow-up . Continued bup/nx treatment across all 4 quarters was associated with improvements in both physical [ β 2.38 ( 95 % CI : 0.63 to 4.12 ) ] and mental [ β 2.51 ( 95 % CI : 0.42 to 4.60 ) ] HRQOL after adjusting for other contributors to HRQOL . Conclusions : Clinic-based bup/nx maintenance therapy is potentially effective in ameliorating some of the adverse effects of opioid dependence on HRQOL for HIV-infected population Objectives : We assessed the feasibility and preliminary efficacy of human immunodeficiency virus ( HIV ) testing with sexual risk reduction counseling for opioid-dependent patients initiating office-based buprenorphine/naloxone treatment . Methods : We conducted a 14-week r and omized , controlled trial with 30 patients ( original target of 114 ) assigned to receive buprenorphine/naloxone induction/stabilization and HIV testing with Brief Sexual Risk Management ( BSRM ) or Enhanced Sexual Risk Management ( ESRM ) .  We evaluated process measures and compared outcomes at baseline and during the 3-month follow-up . Results : Similar proportions of patients receiving BSRM and ESRM underwent HIV testing ( 93 % vs 80 % ; P = 0.28 ) and completed counseling sessions ( 80 % vs 67 % ; P = 0.40 ) . Brief Sexual Risk Management sessions were shorter than ESRM sessions ( 15.4 vs 23.4 minutes ) , with comparable manual adherence ( P = 0.80 ) . Outcomes did not vary by BSRM versus ESRM . Conclusions : Although the recruitment of opioid-dependent patients with sexual risk behaviors is challenging , HIV testing with sexual risk reduction counseling in office-based buprenorphine/naloxone treatment practice is feasible . Interventions to decrease sexual risk behaviors among a segment of this population are necessary Introduction HIV-infected prisoners lose viral suppression within the 12 weeks after release to the community . This prospect i ve study evaluates the use of buprenorphine/naloxone ( BPN/NLX ) as a method to reduce relapse to opioid use and sustain viral suppression among released HIV-infected prisoners meeting criteria for opioid dependence ( OD ) . Methods From 2005–2010 , 94 subjects meeting DSM-IV criteria for OD were recruited from a 24-week prospect i ve trial of  directly administered antiretroviral therapy ( DAART ) for released HIV-infected prisoners ; 50 ( 53 % ) selected BPN/NLX  and were eligible to receive it for 6 months ; the remaining 44 ( 47 % ) selected no BPN/NLX therapy .  Maximum viral suppression ( MVS ) , defined as HIV-1 RNA<50 copies/mL , was compared for the BPN/NLX and non-BPN/NLX ( N = 44 ) groups . Results The two groups were similar , except the BPN/NLX group was significantly more likely to be Hispanic ( 56.0 % v 20.4 % ) , from Hartford ( 74.4 % v 47.7 % ) and have higher mean global health quality of life indicator scores ( 54.18 v 51.40 ) . MVS after 24 weeks of being released was statistically correlated with 24-week retention on BPN/NLX [ AOR = 5.37 ( 1.15 , 25.1 ) ] , having MVS at the time of prison-release [ AOR = 1 
    Output:
    
Studies in opioid treatment setting s ( n = 12 ) identified improving HIV screening uptake and clinical benefits with antiretroviral therapy when provided on-site .
Counseling intensity for OUD medication adherence or HIV-related risk reduction was not associated with clinical benefits .