Methadone Maintenance Plus Syringe Exchange Reduces HIV and HCV Incidence

Sharing syringe and other injection equipment places injection drug users (IDUs) at risk for bloodborne infections like HIV and HCV. Participation in syringe exchange programs plus receipt of methadone maintenance may reduce the likelihood of these infections, although few studies have examined this possibility. Therefore, researchers in Amsterdam assessed the effects of the combination of these strategies among 714 injection drug users at risk for HIV or HCV. 

• Over 20 years of follow-up, neither methadone maintenance alone nor needle exchange alone was significantly associated with HIV or HCV seroincidence.

• However, daily methadone maintenance of ≥60 mg plus no drug injection or injection only with exchanged needles (all in the past 6 months) significantly reduced both HIV and HCV seroincidence (adjusted incidence rate ratios 0.43 and 0.36, respectively, when compared with no methadone maintenance and drug injection without exchanging needles).

Comments:

This study provides prospective evidence that a long-term, comprehensive public strategy to reduce bloodborne infections among IDUs must include both syringe exchange and opioid agonist therapy at effective dose levels.  Although most relevant to policy in countries with recent outbreaks of HIV and HCV among IDUs, these findings are also applicable to communities in the United States that lack adequate access to opioid treatment programs and/or syringe exchange.

Peter D. Friedmann, MD, MPH

Reference:

Van Den Berg C, Smit C, Van Brussel G, et al. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction. 2007;102(9):1454–1462.