HIV-infected patients receiving office-based treatment are more likely to achieve HIV viral suppression, decreasing the overall community viral load and associated HIV incidence. Injection Drug Users are least likely to engage in HIV care and achieve HIV viral suppression compared to other HIV risk groups. Substance abuse treatment can increase engagement in HIV care, but HIV providers have limited options for long-acting office-based addiction treatments. This study will compare extended-release naltrexone to treatment as usual for opioid dependence in HIV-infected patients.