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CK is a 52-year-old woman with AIDS who has been followed since 1990. She has a history of heroin addiction and acquired her HIV infection through intravenous drug use. She has painful peripheral neuropathy (caused by prolonged exposure to ddI and d4T) that has been unresponsive to trials of myriad non-opioid medications. On a regimen of tenofovir/3TC + lopinavir/ritonavir, her viral load is undetectable, and her CD4 count is 225 cells/mm3. She says that because of her unrelenting pain, she has been self-medicating with heroin. What are her treatment options?
An estimated 800,000 to 1 million individuals in the U.S. are addicted to heroin, and in 2008, another 4.7 million were reported to have abused prescription pain med…