BRIEF REPORT: Methadone Treatment of Injecting Opioid Users for Prevention of HIV Infection

Journal of General Internal Medicine (Impact Factor: 3.42). 01/2006; 21(2):193 - 195. DOI: 10.1111/j.1525-1497.2005.00287.x
Source: PubMed

ABSTRACT OBJECTIVE: To assess the effects of oral substitution treatment for opioid-dependent injecting drug users on HIV risk behaviors and infections.DATA SOURCES: Multiple electronic databases were searched. Reference lists of retrieved articles were checked.METHODS: Because of varying methodologies of available studies, this systematic review was limited to a descriptive summary, looking at consistency of outcomes across studies.RESULTS: Twenty-eight studies involving methadone treatment were included in the review. Methadone maintenance treatment is associated with statistically significant reductions in injecting use and sharing of injecting equipment. It is also associated with reductions in numbers of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviors do translate into fewer cases of HIV infection.CONCLUSIONS: Methadone maintenance treatment for injecting drug users significantly reduces the risk of transmission of HIV and should be provided as a component of a strategic approach to the prevention and control of HIV infection. There is insufficient evidence to determine whether other forms of oral substitution treatment also reduce the risk of HIV transmission.


Available from: Linda Gowing, Apr 26, 2015
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    ABSTRACT: People who inject drugs (PWID) are an important group at risk of blood borne infections in Poland. However, robust evidence regarding the magnitude of the problem and geographical variation is lacking, while coverage of prevention remains low. We assessed the potential of combining bio-behavioural studies and case-based surveillance of PWID to gain insight into preventive needs in Poland. Results of a bio-behavioural human immunodeficiency virus (HIV) and hepatitis C virus (HCV) prevalence study among ever injectors in six regions in Poland were compared with HIV case-based surveillance trends from 2000 to 2012. Logistic regression was used for multivariable analyses in the prevalence study. The case surveillance data were correlated with prevalence data, by region, to determine surveillance validity and identify any recent trends. HIV seroprevalence (18% overall) differed more than ten-fold across regions (2.4% to 32%), but HCV seroprevalence and the proportion of PWID sharing needles/syringes in the past 12 months were similar, 44% to 68% and 22% to 29%, respectively. In multivariable models accounting for socio-demographic factors, duration of injecting history and needle sharing practices, regional differences were significant for both HIV and HCV seroprevalence with adjusted odds ratios varying up to a factor of 12.6 for HIV and 3.8 for HCV. The number of new cases of HIV diagnosed in each region during the bio-behavioural study period was strongly correlated (r = 0.93) with HIV prevalence. There was an overall decreasing trend in the number of new diagnoses of HIV over time. However, a transient increase in three regions was preceded by a higher proportion of people with short injecting history (≤5 years) and a high prevalence of HCV coinciding with a low prevalence of HIV in the bio-behavioural study. Bio-behavioural and case-based data were consistent with respect to the regional distribution of HIV and also provided complementary information, with the proportion of new injectors and high HCV prevalence predicting increases in HIV case rates. We identified three regions in Poland that appear to be at increased need for preventive measures. Data point to the need for a stronger investment in harm reduction programmes in Poland.
    BMC Infectious Diseases 12/2015; 15(1). DOI:10.1186/s12879-015-0828-9 · 2.56 Impact Factor
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    ABSTRACT: Compare HIV injecting and sex risk in patients being treated with methadone (MET) or buprenorphine-naloxone (BUP). Secondary analysis from a study of liver enzyme changes in patients randomized to MET or BUP who completed 24-weeks of treatment and had 4 or more blood draws. The initial 1:1 randomization was changed to 2:1 (BUP: MET) after 18 months due to higher dropout in BUP. The Risk Behavior Survey (RBS) measured past 30-day HIV risk at baseline and weeks 12 and 24. Among 529 patients randomized to MET, 391 (74%) were completers; among 740 randomized to BUP, 340 (46%) were completers; 700 completed the RBS. There were significant reductions in injecting risk (p< 0.0008) with no differences between groups in mean number of times reported injecting heroin, speedball, other opiates, and number of injections; or percent who shared needles, did not clean shared needles with bleach, shared cookers, or engaged in front/back loading of syringes. The percent having multiple sex partners decreased equally in both groups (p<0.03). For males on BUP the sex risk composite increased; for males on MET, the sex risk decreased resulting in significant group differences over time (p<0.03). For females, there was a significant reduction in sex risk (p<0.02) with no group differences. Among MET and BUP patients that remained in treatment, HIV injecting risk was equally and markedly reduced, however MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but increased for males on BUP, and decreased for males on MET.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 04/2014; 66(3). DOI:10.1097/QAI.0000000000000165 · 4.39 Impact Factor
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    ABSTRACT: AimsTo determine the relationship between methadone maintenance therapy (MMT) and hepatitis C (HCV) seroconversion among illicit drug users.DesignGeneralized Estimating Equation model assuming a binomial distribution and a logit link function was used to examine for a possible protective effect of MMT use on HCV incidence.SettingData from three prospective cohort studies of illicit drug users in Vancouver, Canada between 1996 and 2012.Participants1004 HCV antibody negative illicit drug users stratified by exposure to MMT.MeasurementsBaseline and semi-annual HCV antibody testing and standardised interviewer administered questionnaire soliciting self-reported data relating to drug use patterns, risk behaviours, detailed sociodemographic data and status of active participation in an MMT program.Findings184 HCV seroconversions were observed for an HCV incidence density of 6.32 [95% confidence interval [CI]: 5.44 – 7.31] per 100 person-years. After adjusting for potential confounders, MMT exposure was protective against HCV seroconversion (Adjusted Odds Ratio [AOR] = 0.47; 95% CI: 0.29 - 0.76). In sub-analyses, a dose-response protective effect of increasing MMT exposure on HCV incidence (AOR = 0.87; 95% CI: 0.78 – 0.97) per increasing 6-month period exposed to MMT was observed.Conclusion Participation in methadone maintenance treatment appears to be highly protective against hepatitis C incidence among illicit drug users. There appears to be a dose-response protective effect of increasing methadone exposure on hepatitis C incidence.
    Addiction 07/2014; 109(12). DOI:10.1111/add.12682 · 4.60 Impact Factor