Does Opioid Agonist Treatment Impact HIV-infected Patients' Use of Antiretroviral Therapy?

Injection drug use (IDU) by patients who take antiretroviral therapy (ART) results in poor medication adherence and worse clinical outcomes. Although substance use treatment can mitigate poor adherence to ART, this benefit has not been consistently demonstrated. Roux and colleagues studied the impact of opioid agonist treatment (OAT) with methadone or buprenorphine for opioid dependence in 276 individuals in France who had become HIV-infected through drug use. Patients were assessed at 6-month intervals (1558 visits) starting from their first ART prescription and categorized with regard to IDU status and receipt of OAT. Outcomes were self-reported ART adherence and HIV viral load suppression. Using logistic regression analysis and adjusting for alcohol consumption, depression, and ART side effects,

 

• adherence to ART was comparable between IDU-negative patients receiving OAT and IDU-negative patients not receiving OAT.

• IDU-positive patients receiving OAT or not receiving OAT had a 2- and 3-fold risk, respectively, of nonadherence.

• viral suppression was associated with duration of IDU-negative status among patients receiving OAT.

Comments:

Cessation of IDU is key to optimizing ART adherence and improving HIV-related outcomes, and these goals are supported by the use of methadone or buprenorphine treatment. These findings highlight the importance of providing substance use treatment as part of HIV care and strongly suggest the benefit of OAT in countries with IDU-driven HIV epidemics now scaling up ART use.

Jeffrey H. Samet, MD, MA, MPH

Reference:

Roux P, Carrieri MP, Villes V, et al. The impact of methadone or buprenorphine treatment and ongoing injection on highly active antiretroviral therapy (HAART) adherence: evidence from the MANIF2000 cohort study. Addiction. 2008;103(11):1828–1836.