Treatment Of Opiate Dependence Research Articles

Retention in medication-assisted treatment for opiate dependence: A systematic review

ABSTRACTRetention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010–2014) found wide variability in retention rates (i.e., 19%–94% at 3-month, 46%–92% at 4-month, 3%–88% at 6-month, and 37%–91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified.

Quantitative EEG and Low-Resolution Electromagnetic Tomography (LORETA) Imaging of Patients Undergoing Methadone Treatment for Opiate Addiction.

Methadone maintenance treatment (MMT) has been used as a treatment for opiate dependence since the mid-1960s. Evidence suggests that methadone binds to mu opiate receptors as do other opiates and induces changes in neurophysiological function. However, little is known, about how neural activity within the higher frequency gamma band (>30 Hz) while at rest changes in those stabilized on MMT despite its association with the excitation-inhibition balance within pyramidal-interneuron networks. Our study investigated differences in resting gamma power (37-41 Hz) between patients undergoing MMT for opiate dependence, illicit opiate users, and healthy controls subjects. Electroencephalographic data were recorded from 26 sites according to the international 10-20 system. Compared with the healthy controls subjects, people either undergoing MMT (mean difference [MD] = 0.32, 95% CI = 0.09-0.55, P < .01) or currently using illicit opiates (MD = 0.31, 95% CI = 0.06-0.56, P = .01) exhibited significant increased gamma power. The sLORETA (standardized low-resolution electromagnetic tomography) between-group comparison revealed dysfunctional neuronal activity in the occipital, parietal, and frontal lobes in the patients undergoing MMT. A more severe profile of dysfunction was observed in those using illicit opiates. Our findings suggest that long-term exposure to opioids is associated with disrupted resting state network, which may be reduced after MMT.

Analysis of connectivity in NeuCube spiking neural network models trained on EEG data for the understanding of functional changes in the brain: A case study on opiate dependence treatment

The paper presents a methodology for the analysis of functional changes in brain activity across different conditions and different groups of subjects. This analysis is based on the recently proposed NeuCube spiking neural network (SNN) framework and more specifically on the analysis of the connectivity of a NeuCube model trained with electroencephalography (EEG) data. The case study data used to illustrate this method is EEG data collected from three groups—subjects with opiate addiction, patients undertaking methadone maintenance treatment, and non-drug users/healthy control group. The proposed method classifies more accurately the EEG data than traditional statistical and artificial intelligence (AI) methods and can be used to predict response to treatment and dose-related drug effect. But more importantly, the method can be used to compare functional brain activities of different subjects and the changes of these activities as a result of treatment, which is a step towards a better understanding of both the EEG data and the brain processes that generated it. The method can also be used for a wide range of applications, such as a better understanding of disease progression or aging.

Mania following use of ibogaine: A case series

Ibogaine is a naturally occurring hallucinogen with postulated anti-addictive qualities. While illegal domestically, a growing number of individuals have sought it out for treatment of opiate dependence, primarily in poorly regulated overseas clinics. Existing serious adverse events include cardiac and vestibular toxicity, though ours is the first report of mania stemming from its use. To report on a case series of psychiatric emergency room patients whose unregulated use of ibogaine resulted in mania in three patients with no prior diagnosis of bipolar illness. Review and summarize charts of three cases. Relevant literature was also reviewed for discussion. Two cases of reported ibogaine ingestion for self-treatment of addictions, and one for psycho-spiritual experimentation resulted in symptoms consistent with mania. No prior reports of mania were found in the literature, and the literature suggests growing popularity of ibogaine's use. The three cases presented demonstrate a temporal association between ibogaine ingestion and subsequent development of mania. In light of these cases, clinicians faced with a new onset mania may benefit from careful substance use and treatment history, specifically regarding opiates. In the vulnerable and often desperate addiction population, in particular, the number of patients seeking this treatment appears to be growing. We advise clinicians to be prepared for discussing the safety, efficacy, and paucity of good data regarding ibogaine with patients who may be considering its use. (Am J Addict 2015;24:203-205).

Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–10

To estimate mortality rates among treated opioid-dependent individuals by cause and in relation to the general population, and to estimate the instantaneous effects of opioid detoxification and maintenance treatment (MMT) on the hazard of all-cause and cause-specific mortality. Population-based treatment cohort study. Linked mortality data on all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010. A total of 32 322 individuals, among whom there were 1031 deaths (3.2%) over a median follow-up of 2.6 years (interquartile range = 1.4-3.7). The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR) and standardized mortality ratios (SMR). Individuals being treated for opioid dependence had a more than fourfold increase of mortality risk compared with the general population [SMR = 4.5, 95% confidence interval (CI) = 4.2, 4.8]. Mortality risk was higher (1) when individuals were out-of-treatment (SMR = 6.1, 95% CI = 5.7, 6.5) than in-treatment (SMR = 1.8, 95% CI = 1.6, 2.1) and (2) during detoxification (SMR = 2.4, 95% CI = 1.5, 3.8) than during MMT (SMR = 1.8, 95% CI = 1.5, 2.1), especially in the 2 weeks post-treatment entry (SMR = 5.5, 95% CI = 2.7, 9.8 versus SMR = 2.5, 95% CI = 1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all-cause and drug-related mortality. MMT preceded by detoxification was associated with lower all-cause and other cause-specific mortality than MMT alone. In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.

Opiate Substitute Prescription and Interactions with Anti-HIV Drugs.

Introduction Injecting Drug use is a major risk factor for the acquisition and transmission of HIV and accounts for approximately 5-10% of HIV infections worldwide. Opiate Substitution Treatment using Methadone and Buprenorphine reduces the HIV risk for people who inject drugs by up to half. Therefore proper diagnosis and treatment of opiate dependence are essential. Both Methadone and Buprenorphine have been shown to interact with a lot of anti-retroviral medications. This may lead to potentially toxic drug interactions. This could also lead either to withdrawal symptoms or to morbidity/mortality by overdose if these medications are not prescribed carefully. Aims & Objectives Our objectives were to look for the relationship between substance abuse and HIV and to analyze the interactions and adverse reactions when combining Methadone/Buprenorphine and Antiretrovirals. Methodology Using MEDLINE, English literature was reviewed from 1990 to June 2014. The search strategy was 'Substance abuse” OR 'Drug abuse” OR Methadone OR Buprenorphine AND HIV OR AIDS OR HAART. Results Subjects who use drugs are more prone to acquire HIV because of increased risky behaviours. Substitute Opiate treatment may improve adhesion to the antiretroviral treatment and also leads to a reduction in risk-taking behaviours. In the poster, we will be presenting the interactions of each Anti-Retroviral agent with both Methadone and Buprenorphine. Conclusion Choosing the best therapeutic intervention in each case, particularly considering those drugs with least interactions and adverse effects is crucial for the success of Opiate substitution programme and also to combat the HIV infection.

Clinical Efficacy of Traditional Chinese Medicine, Suan Zao Ren Tang, for Sleep Disturbance during Methadone Maintenance: A Randomized, Double-Blind, Placebo-Controlled Trial.

Methadone maintenance therapy is an effective treatment for opiate dependence, but more than three-quarters of persons receiving the treatment report sleep quality disturbances. In this double-blind, randomized, controlled trial, we recruited 90 individuals receiving methadone for at least one month who reported sleep disturbances and had Pittsburgh Sleep Quality Index (PSQI) scores > 5. The purpose of this study was to determine whether Suan Zao Ren Tang, one of the most commonly prescribed traditional Chinese medications for treatment of insomnia, improves subjective sleep among methadone-maintained persons with disturbed sleep quality. Ninety patients were randomly assigned to intervention group (n = 45) and placebo group (n = 45), and all participants were analyzed. Compared with placebo treatment, Suan Zao Ren Tang treatment for four weeks produced a statistically significant improvement in the mean total PSQI scores (P = 0.007) and average sleep efficiency (P = 0.017). All adverse events (e.g., lethargy, diarrhea, and dizziness) were mild in severity. Suan Zao Ren Tang is effective for improving sleep quality and sleep efficiency among methadone-maintained patients with sleep complaints.

Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers.

BackgroundSince its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians’ offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind.ResultsThrough a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma.ConclusionAs the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.

Long-term patterns of heroin use and mental health: 11-Year follow-up of the Australian treatment outcome study

s / Drug and Alcohol Dependence 146 (2015) e118–e201 e193 associated with fewer child INT at age 4.5 years and a reduction in child INT from 4.5 to 6 years. Conclusions: Thus, drug use and tobacco use, the strongest prenatal risks, may increase youths’ sensitivity to environmental cues (evidenced by increased morning cortisol). Whereas generally this sensitivity to environmental cues would translate into more problems in youth who would experience an environment consistent with the genetic and prenatal risk (i.e., parental SU), in this study children were adopted into generally positive environments. Thus, in this sample children exposed to drug and tobacco use may be able to take advantage of the generally positive environmental influences because of altered cortisol function. Financial support: R01HD042608, R01MH092118, F31DA033737 and T32DA016184. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.439 Long-term patterns of heroin use and mental health: 11-Year follow-up of the Australian treatment outcome study Christina Marel1, Maree Teesson1, Katherine Mills1, Shane Darke1, Joanne Ross1, Tim Slade1, Lucy Burns1, Michael Lynskey2 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia 2 Washington University, St Louis, MO, United States Aims: Heroin dependence is a chronic and in many cases, lifelong condition, associated with comorbid mental health disorders. Using data collected as part of the Australian Treatment Outcome Study, the present paper aims to examine the major findings of heroin use, comorbid disorders and treatment patterns over 10–11 years. Methods: 615 people with heroin dependence were recruited to the study in 2001–2002, and re-interviewed at 3-, 12-, 24-, 36months and10–11years post-baseline (follow-up rates of 89%, 81%, 76%, 70% and 69% at the time of writing). Heroin dependence was assessedat each timepointusing theComposite InternationalDiagnostic Interview version 2.1, and heroin treatment since the last interview was obtained using the timeline follow-back method. Results: At 11-years, preliminary analyses indicate that over 14% of the cohort endorsed criteria for heroin dependence and 47% were in treatment for opiate dependence. One fifth of the cohort met criteria for current depression; 41% for current post traumatic stress disorder (PTSD); and22%had committed at least one crime in thepastmonth. Theoverwhelmingmajority of the cohort (98%)had experienced a period of abstinence in the follow-up period, with a median period of consecutive abstinence of 60 months (5 years). Overall, physical and mental health was poorer than population norms. Just over 10% of the cohort were deceased. Conclusions: Despite significant reductions in heroin use and dependence over the 11-year follow-up period, there were continued high rates of other comorbidities. Further, although a significant proportion of the cohort achieved continual abstinence for substantial portions of the follow-up period, preliminary findings highlight the importance for long-term treatment for this chronic debilitating condition. Financial support: The study was funded by the Australian National Health and Medical Research Council. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.440 Cocaine-dependent subjects display attentional bias toward cocaine-related but not alcohol-related stimuli Katherine R. Marks1,3, William W. Stoops1,3, Craig R. Rush1,2,3 1 Behavioral Science, University of Kentucky, Lexington, KY, United States 2 Psychiatry, University of Kentucky, Lexington, KY, United States 3 Psychology, University of Kentucky, Lexington, KY,

Are empty methadone bottles empty? An analytic study.

BackgroundMethadone maintenance treatment is the most widely prescribed treatment for opiate dependence with proven benefits for patients. In naïve users or in case of recreational misuse, methadone can be a source of potentially lethal intoxications, resulting in fatal overdoses. A few cases of infantile intoxications have been described in the literature, some of which resulted in death. Nowadays, more than 50,000 bottles are used every day in France, most of which are thrown away in the bin. Relatives at home, especially children, can have access to these empty bottles. This study aims to determine whether the residual quantity of methadone in the bottles is associated with a risk of intoxication for someone who has a low tolerance to opiates, such as a child.MethodsThe methadone dosage left in a sample of 175 bottles recapped after use by the patients taking their maintenance treatment in an addiction treatment program centre was analysed during a 2-week period in March 2013.ResultsThe mean residual quantity of methadone left in each bottle after use is 1.9 ± 1.8 mg and 3.3 ± 2.4 mg in the sample of 60 mg bottles.ConclusionsThere is a potential danger of accidental overdose with empty bottles of methadone syrup, especially for children. To take into account this hazard, several harm reduction strategies can be proposed, such as favouring the taking of the treatment within the delivery centres rather than the ‘take home’ doses, asking methadone users to bring back their used bottles, and raising patients’ awareness of the intoxication risks and the necessary everyday precautions. For stable patients with take home methadone, the use of capsules could be considered.

A pilot study of a distress tolerance treatment for opiate-dependent patients initiating buprenorphine: rationale, methodology, and outcomes.

Buprenorphine, an opioid that is a long-acting partial opiate agonist, is an efficacious treatment for opiate dependence that is growing in popularity. Nevertheless, evidence suggests that many patients will lapse within the first week of treatment and that lapses are often associated with withdrawal-related or emotional distress. Recent research suggests that individuals' reactions to this distress may represent an important treatment target. In the current study, we describe the development and outcomes from a preliminary pilot evaluation (N = 5) of a novel distress tolerance (DT) treatment for individuals initiating buprenorphine. This treatment incorporates exposure-based and acceptance-based treatment approaches that we have previously applied to the treatment of tobacco dependence. Results from this pilot study establish the feasibility and acceptability of this approach. We are now conducting a randomized controlled trial of this treatment that we hope will yield clinically significant findings and offer clinicians an efficacious behavioral treatment to complement the effects of buprenorphine.

WITHDRAWN: Psychosocial treatment for opiate abuse and dependence.

WITHDRAWN: Psychosocial treatment for opiate abuse and dependence.

Methadone Maintenance Treatment and Cognitive Function: A Systematic Review

Methadone has been used as a pharmacotherapy for the treatment of opiate dependence since the mid-1960s. Many studies examining the benefits of methadone maintenance treatment (MMT) for opiate dependence have documented a significant reduction in both criminal behavior and the use of other opiates. Nevertheless, emerging evidence suggests that MMT may impair cognitive function. However, it is unclear as to the part methadone dose, duration of MMT or plasma level may play in any observed deficits. Given the large number of people enrolled in MMT world-wide and the potential for deficits in cognitive function, a systematic review of the research investigating the association between MMT and cognitive function seemed warranted. The following databases were searched with a combination of free-text and thesaurus terms (methadone AND cognition): MEDLINE In-Process, EMBASE, PsycINFO and EBM Reviews-Cochrane Central Register of Controlled Trials. Seventy-eight articles were retrieved of which 35 met the inclusion criteria. The majority of research suggests that MMT is associated with impaired cognitive function and that deficits extended across a range of domains. However, caution is required when interpreting these results due to the methodological limitations associated with many studies. Further research that includes a combination of psychological and physiological measures within well-controlled group comparison studies is required to more accurately assess which cognitive domains are affected.

Psychiatrist-Anthropologist Studies Drug Addiction and Recovery

Psychiatrist-Anthropologist Studies Drug Addiction and Recovery

Clinical efficacy of acupuncture as an adjunct to methadone treatment services for heroin addicts: a randomized controlled trial.

Scant scientific evidence supports the efficacy of acupuncture in the treatment of opiate dependence. The purpose of this study was to examine the effectiveness of acupuncture for heroin addicts on methadone maintenance by measuring the daily consumption of methadone, variations in the 36-item Short Form Health Survey-36 (SF-36) and Pittsburgh Sleep Quality Index (PSQI) scores, and heroin craving. Sixty heroin addicts were randomly assigned to true acupuncture (electroacupuncture at the Hegu [LI4] and Zusanli [ST36] acupoints, as well as acupuncture at the Ear Shenmen) or sham acupuncture (minimal acupuncture at the Hegu and Zusanli acupoints without electrical stimulation and superficial acupuncture at the Ear Shenmen), twice weekly for 4 weeks. From week 2 onwards, the daily dose of methadone was reduced by a significantly greater amount with true acupuncture compared with sham acupuncture. True acupuncture was also associated with a greater improvement in sleep latency at follow-up. All adverse events were mild in severity. Acupuncture appears to be a useful adjunct to methadone maintenance therapy (MMT) in heroin addiction.

A Novel Community-Based Buprenorphine Program

The aims of this retrospective, descriptive study were to describe clients served by a buprenorphine program in a community-based recovery center and to present initial treatment outcomes. A record review was conducted for clients treated from July 2010 to August 2011. Client demographic, health, substance use, and treatment history data were abstracted from the records of the first 78 clients served. Buprenorphine and opiate use data were collected via urine toxicology reports, collected weekly among clients who remained enrolled in treatment. The average percentages of weeks spent opiate free and buprenorphine compliant were 83% (SD = 26%) and 95% (SD = 13%), respectively. When positive heroin toxicology and negative buprenorphine toxicology were replaced for the missing/unknown data, the average percentages of opiate-abstinent weeks and buprenorphine compliance were 60% (SD = 34%) and 74% (SD = 28%), respectively. Roughly half of all clients (49%) were successfully transitioned to continue treatment with buprenorphine in a primary care setting. Findings from this study demonstrate that buprenorphine treatment for opiate dependence can be incorporated into a community-based recovery center with high rates of opiate abstinence and treatment adherence.

Hypothalamic Pathophysiology in the Neuroimmune,Dysmetabolic and Longevity Complications of Chronic Opiate Dependency

Hypothalamic Pathophysiology in the Neuroimmune,Dysmetabolic and Longevity Complications of Chronic Opiate Dependency New conceptual and therapeutic advances in our understanding of various important pathophysiological states have remarkable relevance to current practices in the area of the treatment of opiate dependence. Major breakthroughs have recently occurred in our understanding of: The central mediation of the hypertensive-obesity-metabolic syndrome and particularly its association with the hypothalamic regulation of longevity; The ability of addictive chemical species to induce local inflammation of many parts of the CNS including the hypothalamus; The interactions between the host and the resident gut microbial flora and its implications for systemic organismal health and disease. These breakthroughs have occurred on the backdrop of detailed quantified pathophysiological and mortality surveys of opiate dependence from several continents and in the context of exciting new pharmacological developments including suppressors of central neuroinflammation such as ibudilast, non-habituating newer generation opiates such as PTI-609, and depot-implantable forms of the opiate antagonist naltrexone. Opiates induce electrical silencing of POMC neurons resulting in hyperphagic obesity and dysmetabolic syndrome, mimicking senescence. Hence POMC neuronal pathophysiology becomes amplified organism-wide in a feed-forward loop. Together these factors suggest that we are on the very threshold of new insights which have the potential to overhaul both our conceptual understandings and our clinical treatments. The purpose of this review is to bring together findings from widely disparate areas and to elucidate their relevance and overlap with research on the effects of long-term opiate dependence. Whilst opiate dependence is the primary focus these observations likely also pertain to other chemical dependencies.

Illicit and Prescription Opiate Dependence: The Impact of Axis II Psychiatric Comorbidity on Detoxification Outcome

Objective: The current study examined the predictors of inpatient detoxification failure among illicit and prescription opiate dependent patients. Outcomes for the treatment of opiate dependence were compared to those with sedativehypnotic dependence. Methods: Data from 203 consecutive detoxification admissions included results of urine toxicology screens, length of stay, and outcomes. All detoxification protocols were designed to manage withdrawal throughout the tapering process and medical/psychiatric monitoring was provided daily. Results: Opiate-dependent patients were significantly less likely to complete detoxification and more likely to dropout against medical advice or to be discharged for non-compliance compared to sedative-hypnotic dependent patients. Those with opiate dependence were also more likely to be polysubstance abusers, and to report that they suffered some form of chronic pain syndrome (e.g. fibromyalgia) compared to the non-opiate group. Additionally, a large percentage of the sample was diagnosed with a personality disorder (PD), primarily Cluster B PD. There was considerable overlapping comorbidity between PD, pain syndromes and opiate abuse; 31.6% of the opiate-dependent patients suffered from both a chronic pain condition and a PD compared to 4.0% of the non-opiate patients. A hierarchical logistic regression revealed that treatment failure was predicted by three significant variables – younger age, opiate dependence and the presence of a Cluster B personality disorder. Illicit opiate (IO) users differed significantly from prescription opiate (PO) users in that they were significantly younger at first use of opiates and at the time of detoxification. Time between first use and detoxification admission did not significantly differ between the groups and rates of detoxification completion were comparable. Conclusions: Overall, these findings suggest a complex interaction between opiate dependence, pain syndromes, and affective dysregulation, which may lead to early termination from treatment.Further understanding of treatment failure may lead to specific, targeted interventions for thisdifficult to treat population.

Medical Assisted Treatment of Opiate Dependence with Buprenorphine/Naloxon (Suboxone®) of Heroin Addicts in Prison Who Are Aging Penalties

Aim: To describe the treatment of opiate addicts who had to spend certain period in prison, after introduced in outpatient administering of substitution medicament Buprenorphine/Naloxon in Bosnia-Herzegovina. Methodology: We assessed 10 male opiate addicts aged 24.8±4.7 years. With presentation of clinical vignettes, authors described how opiate dependants with criminal past imprisoned in jail because of aging penalties avoided discontinuation of treatment after they were included in the Buprenorphine/Naloxon maintenance treatment program. This practice has been implemented in cooperation of Department of Psychiatry in Tuzla and Tuzla prison from 27 July 2009. Results: All opiate dependants described with clinical vignettes showed surprised with positive effects on overall outcomes of Buprenorphine/Naloxon after implementation of continual treatment in prison in cooperation with jail officers (nurse and guards). Also they were very satisfied with life quality during treatment in prison. Also jail officers, family members of dependant person showed satisfaction with achieved efficacy of Buprenorphine/Naloxon eider during aging penalties. Conclusion: Medically assisted treatment of opiate dependence with Buprenorphine/Naloxon for imprisoned addicts implemented as outpatient treatment with involvement of jail officers who were instructed in Buprenorphine/Naloxon daily administration, improved quality of life of treated opiate dependants, and quality of their relations in prison with others.

The Influence of Psychological Variables on Health-Related Quality of Life among HIV-Positive Individuals with a History of Intravenous Drug Use

Objective: Intravenous drug use (IDU) remains a prominent pathway of HIV transmission in the United States, though little is known about modifiable factors influencing quality of life among IDUs. The goal of this study was to evaluate the influence of psychological variables (e.g., depression and anxiety) on health-related quality of life among HIV-positive individuals with a history of IDU who were enrolled in outpatient treatment for opioid dependence. Method: 108 HIV-positive individuals with a history of IDU and participating in current outpatient treatment for opiate dependence who were screened for participation in a depression and adherence study reported sociodemographic data, depressive and anxiety symptoms, and health-related quality of life (HRQoL; Multidimensional Health Assessment using the ACTG-SF 21). Results: Multiple regression models controlling for disease stage and background characteristics identified significant negative relationships between General Health Perception and Functioning without Pain for anxiety and depression, and between Role Functioning and Physical Functioning for anxiety. CD4 cell count was significantly related to Physical Functioning only. Conclusions: Results indicate that distress (both depression and anxiety) contribute significantly to variation in HRQoL over and above the effects of disease variables. Effective depression and anxiety treatment may result in improved overall functioning.