Search   |  Advanced

Research Summary

HIV Infection Incidence Is Reduced 54% in People with Injection Drug Use Who Receive Opioid Agonist Treatment

Cohort studies have demonstrated that opioid-dependent people with injection drug use who receive opioid agonist treatment (OAT) have lower HIV infection rates than those not receiving OAT. Researchers conducted a meta-analysis to quantify the association between OAT receipt and HIV incidence. Data from 12 published and 3 unpublished prospective studies that measured HIV incidence and OAT exposure were included in the study, 9 of which were sufficiently similar to include in the main meta-analysis. Overall, 819 incident HIV infections over 23,608 person years were included.

  • Opioid agonist treatment was associated with a 54% reduction in HIV incidence (rate ratio [RR], 0.46).
  • The benefit was consistent, although it diminished when the meta-analysis was limited to 6 studies that allowed adjustment for confounders (RR, 0.60) or to 5 studies that had less bias (RR, 0.61).
  • The benefit did not vary by geographical region, study site, provision of incentives, gender, or ethnicity.
  • In the 4 studies that measured it, detoxification with methadone was associated with an increased risk of HIV transmission compared with no treatment or OAT (RR, 1.54).


This meta-analysis provides strong support for OAT as a key public health tool to reduce HIV incidence in people with opioid dependence who inject drugs. People undergoing methadone detoxification should be offered HIV risk-reduction interventions to address higher HIV incidence. Alexander Y. Walley, MD, Msc


MacArthur GJ, Minozzi S, Martin N, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ. 2012;345:e5945.