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 Data from 12 published and 3 unpublished prospective studies that measured HIV incidence and OAT exposure were included in the study, 9 of which were sufficiently similar to include in the main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).

Comments:

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

Reference:

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.