Among People with HIV Who Inject Drugs, Incarceration Is A Barrier To Antiretroviral Therapy While Engagement In Methadone Treatment Promotes It

Current guidelines recommend initiation of antiretroviral therapy (ART) for all individuals with HIV, both to improve clinical outcomes and to reduce transmission. People who inject drugs (PWID) are at risk for HIV infection and are less likely to engage in ART. Researchers used data from 2 cohorts of PWID in Vancouver, Canada—where access to ART is available at no cost—to investigate the association between initiation of ART and other factors.

• Of 133 participants who met inclusion criteria, 98 (74%) initiated ART during the study period.
• On multivariable analyses, engagement in methadone maintenance was positively associated with initiation of ART (adjusted hazard ratio [aHR], 2.41). Two factors were negatively associated with initiation of ART: engaging in informal income generation (sex work, drug dealing, theft, or other activities; aHR, 0.51) and incarceration (aHR, 0.52).
• Factors that were not significantly associated with initiation of ART included age, gender, race, education, and homelessness.

Comments:

The findings of this study are consistent with prior observations that engagement in opioid agonist treatment facilitates the treatment of HIV. With regard to incarceration, the findings are not consistent with some studies that have shown that this can facilitate the initiation and optimization of ART. In any case, HIV care should include agonist treatment for those who need it and involvement with the criminal justice system should be used as an opportunity to address both addiction and HIV infection.

Darius A. Rastegar, MD

Reference:

Joseph B, Wood E, Hayashi K, et al. Factors associated with initiation of antiretroviral therapy among HIV-positive people who use injection drugs in a Canadian setting. AIDS. 2016;30:925–932.