Patients with HIV infection and Opioid Use Who Receive Methadone Maintenance Are More Likely to Initiate and Adhere to Antiretroviral Therapy

People with HIV-infection and injection drug use (IDU) are less likely to initiate and adhere to antiretroviral therapy (ART) than those with no IDU. Methadone maintenance treatment (MMT) reduces IDU and may improve adherence to ART. To determine whether MMT is positively associated with ART initiation and adherence, researchers studied a cohort of 231 ART-naïve opioid users with HIV infection and IDU in Vancouver between 1996 and 2008, comparing the 24% of subjects receiving MMT at baseline with those who were not. Follow-up was at 24 months.

• The cumulative incidence rate of ART initiation was 64% for patients who were receiving MMT at baseline and 45% for those who were not.

• After accounting for viral load and CD4+ cell count, subjects receiving MMT were more likely to initiate ART than those who were not (relative hazard ratio, 1.62).

• Among the 152 subjects who initiated ART during the study period, subjects on MMT were more likely to achieve 95% or greater adherence to ART than those who were not (adjusted odds ratio, 1.49).

Comments:

Although this study does not provide biologic adherence outcomes, such as change in CD4+ cell count or viral load, it does demonstrate a positive association between MMT and ART initiation and adherence. These findings support the World Health Organization’s recommendation that opioid agonist treatment be accessible to opioid-dependent HIV-infected individuals.

Alexander Y. Walley, MD, MSc

Reference:

Uhlmann S, Milloy MJ, Kerr T, et al. Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users. Addiction. 2010;105(5):907–913.