BRIEF REPORT: Methadone Treatment of Injecting Opioid Users for Prevention of HIV Infection
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.
Full-textDOI: · Available from: Linda Gowing, May 10, 2015
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ABSTRACT: Injection opioid use plays a significant role in the transmission of HIV infection in many communities and several regions of the world. Access to evidence-based treatments for opioid use disorders is extremely limited. HPTN 058 was a randomized controlled trial designed to compare the impact of two medication assisted treatment (MAT) strategies on HIV incidence or death among opioid dependent people who inject drugs (PWID). HIV-negative opiate dependent PWID were recruited from four communities in Thailand and China with historically high prevalence of HIV among PWID. 1251 participants were randomly assigned to either; 1) a one year intervention consisting of two opportunities for a 15 day detoxification with buprenorphine/naloxone (BUP/NX) combined with up to 21 sessions of behavioral drug and risk counseling (Short Term Medication Assisted Treatment: ST-MAT) or, 2) thrice weekly dosing for 48 weeks with BUP/NX and up to 21 counseling sessions (Long Term Medication Assisted Treatment: LT-MAT) followed by dose tapering. All participants were followed for 52 weeks after treatment completion to assess durability of impact. While the study was stopped early due to lower than expected occurrence of the primary endpoints, sufficient data were available to assess the impact of the interventions on drug use and injection related risk behavior. At weeks 26, 22% of ST-MAT participants had negative urinalyses for opioids compared to 57% in the LT-MAT (p<0.001). Differences disappeared in the year following treatment: at week 78, 35% in ST-MAT and 32% in the LT-MAT had negative urinalyses. Injection related risk behaviors were significantly reduced in both groups following randomization. Participants receiving BUP/NX three times weekly were more likely to reduce opioid injection while on active treatment. Both treatment strategies were considered safe and associated with reductions in injection related risk behavior. These data support the use of thrice weekly BUP/NX as a way to reduce exposure to HIV risk. Continued access to BUP/NX may be required to sustain reductions in opioid use.JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2015; 68(5). DOI:10.1097/QAI.0000000000000510 · 4.39 Impact Factor
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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 02/2015; 15(1):83. DOI:10.1186/s12879-015-0828-9 · 2.56 Impact Factor
Addiction 04/2015; 110(4):656-7. DOI:10.1111/add.12865 · 4.60 Impact Factor