Oral substitution treatment of injecting opioid users for prevention of HIV infection

Discipline of Pharmacology, University of Adelaide, Frome Road, Adelaide, South Australia, Australia, 5005.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2011; 10(8):CD004145. DOI: 10.1002/14651858.CD004145.pub4
Source: PubMed

ABSTRACT Injecting drug users are vulnerable to infection with Human Immunodeficiency Virus (HIV) and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour
To assess the effect of oral substitution treatment for opioid dependent injecting drug users on risk behaviours and rates of HIV infections
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO to May 2011. We also searched reference lists of articles, reviews and conference abstracts
Studies were required to consider the incidence of risk behaviours, or the incidence of HIV infection related to substitution treatment of opioid dependence. All types of original studies were considered. Two authors independently assessed each study for inclusion
Two authors independently extracted key information from each of the included studies. Any differences were resolved by discussion or by referral to a third author.
Thirty-eight studies, involving some 12,400 participants, were included. The majority were descriptive studies, or randomisation processes did not relate to the data extracted, and most studies were judged to be at high risk of bias. Studies consistently show that oral substitution treatment for opioid-dependent injecting drug users with methadone or buprenorphine is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion 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 behaviours related to drug use do translate into reductions in cases of HIV infection. However, because of the high risk of bias and variability in several aspects of the studies, combined totals were not calculated.
Oral substitution treatment for injecting opioid users reduces drug-related behaviours with a high risk of HIV transmission, but has less effect on sex-related risk behaviours. The lack of data from randomised controlled studies limits the strength of the evidence presented in this review.

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Available from: Robert Leonard Ali, Aug 30, 2015
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    • "Established interventions for HIV prevention for these populations and their partners include needle and syringe exchange programs; condoms; and expanded combination antiretroviral therapy for HIV-infected individuals (Marshall and Wood, 2010). In addition, there is growing support for the effectiveness of opioid agonist treatment (OAT), including methadone and buprenorphine, at decreasing HIV risk behaviors among uninfected patients (Sullivan et al., 2008; Gowing et al., 2011; MacArthur et al., 2012). Available in the United States since 2002, buprenorphine is a partial mu-receptor agonist effective at treating opioid dependence (Sullivan and Fiellin, 2008; Mattick et al., 2008) and is included in http://dx.doi. "
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    ABSTRACT: Background Opioid dependence is a major risk factor for HIV infection, however, the impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected opioid-dependent patients is unknown. Methods We conducted a longitudinal analysis of 303 HIV-infected opioid-dependent patients initiating buprenorphine/naloxone treatment. Outcomes included self-reported past 90-day needle-sharing and non-condom use. We assessed trends over the 12 months using the Cochran-Armitage trend test. Using Generalized Estimating Equations, after multiple imputation, we determined factors independently associated with needle-sharing and non-condom use, including time-updated variables. We then conducted a mediation analysis to determine whether substance use explained the relationship between time since treatment initiation and needle-sharing. Results Needle-sharing decreased from baseline to the fourth quarter following initiation of buprenorphine/naloxone (9% vs. 3%, p < 0.001), while non-condom use did not (23% vs. 21%, p = 0.10). HIV risk behaviors did not vary based on the presence of a detectable HIV-1 RNA viral load. Patients who were homeless and used heroin, cocaine/amphetamines or marijuana were more likely to report needle-sharing. Heroin use fully mediated the relationship between time since treatment initiation and needle-sharing. Women, patients who identified as being gay/lesbian/bisexual, those married or living with a partner and who reported heroin or alcohol use were more likely to report non-condom use. Older patients were less likely to report non-condom use. Conclusions While buprenorphine/naloxone is associated with decreased needle-sharing among HIV-infected opioid-dependent patients, sexual risk behaviors persist regardless of viral load. Targeted interventions to address HIV risk behaviors among HIV-infected opioid-dependent populations receiving buprenorphine/naloxone are needed.
    Drug and alcohol dependence 06/2014; 139. DOI:10.1016/j.drugalcdep.2014.03.006 · 3.28 Impact Factor
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    • "There is substantial evidence that opiate substitution treatment reduces the risk of HCV transmission among PWID,37,38 and a further risk reduction can be achieved by simultaneous participation in needle and syringe programs and opiate substitution treatment.39,40 Nonetheless, data on the effectiveness of opiate substitution treatment and needle and syringe programs for primary prevention of hepatitis C infection and subsequent modeling show that these interventions do not necessarily lead to substantial reductions in HCV prevalence. "
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    ABSTRACT: Hepatitis C virus (HCV) infections are highly prevalent amongst people who inject drugs (PWID). Despite well documented evidence of its effectiveness, suggested cost-effectiveness, and potential to reduce HCV prevalence rates, the uptake of antiviral HCV treatment by PWID is low. This nonsystematic literature review describes factors associated with the uptake, adherence, and efficacy of HCV treatment among PWID and discusses strategies to increase their uptake of treatment. Low HCV treatment uptake among PWID is associated with a number of patient-related and provider-related barriers. Beliefs and fears about low efficacy and adverse effects on the patient's part are common. A substantial number of factors are associated with the chaotic lifestyle and altered social functioning of PWID, which are often associated with decompensation or relapsing into drug addiction. This may lead to perceived low adherence with treatment and low efficacy on the provider's part too, where lack of support, inadequate management of addiction, and other drug-related problems and poor treatment of side effects have been described. Practical issues such as the accessibility of treatment and finances also play a role. Strategies to improve the HCV treatment rate among PWID involve pretreatment management and assessment, a multidisciplinary approach, management of side effects, and enhanced education and counseling. Specific factors are associated with poorer treatment outcomes in PWID on the side of both the patient and the treatment system. However, given that PWID can achieve treatment adherence and sustained virologic response rates comparable with those in nondrug users, drug use per se should not be considered a criterion for exclusion from treatment. Further development of measures leading to higher uptake of treatment and adherence in PWID and appropriate adaptation of HCV treatment guidelines represent important tools in this regard.
    Patient Preference and Adherence 10/2013; 7:1067-1075. DOI:10.2147/PPA.S49113 · 1.49 Impact Factor
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    • "ethadone is a slow-onset, long-acting, µ-opioid receptor agonist that is used as a safe and effective pharmacologic treatment for opioid dependence (O'Brien, 1997). Delivered in conjunction with other supportive services, methadone maintenance treatment (MMT) has been shown to reduce illicit—heroin and prescription—opioid use, criminal activity , and drug-related behaviors that increase risk for the transmission of viruses such as human immunodeficiency virus and Hepatitis C (Hubbard, 1989; Ball & Ross, 1991; Marsch, 1998; Gowing et al., 2008). When compared to no treatment, MMT also reduces mortality rates (Clark et al., 2011). "
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    ABSTRACT: Methadone maintenance treatment (MMT) effectively reduces illicit opioid use and its negative consequences when patients participate in and adhere to treatment. Patients' participation and adherence may relate to their perceptions about methadone doses and dose adjustments and the meanings that patients associate with treatment. This study assessed patient perceptions about methadone dosing and the meanings associated with methadone treatment to better support patient adherence to and success in MMT. We conducted semistructured interviews with 19 patients in an urban MMT program. Interviews were transcribed verbatim and analyzed through an iterative process. Participants' expressed perceptions about methadone doses related to ideas of "comfort" and "function," suggesting a model for determining dose appropriateness and "ideal" methadone dose based on various factors both intrinsic and extrinsic to MMT. Intrinsic factors included those exerting downward pressure on "ideal" methadone dose such as lack of control in treatment, disdain for getting "high," concerns about methadone dependence, and desire to avoid adverse effects; those exerting upward pressure such as concern about withdrawal; and those exerting mixed pressures such as methadone formulations. Extrinsic factors included those exerting downward pressure such as shame about and stigma around MMT; those exerting upward pressure such as medical conditions and medication interactions; and those exerting mixed pressures such as family and peer relationships. Participants held perceptions about methadone dosing that included considerations beyond typical medical parameters used by physicians and other MMT providers to determine appropriate methadone doses. The model that emerged from our data could help inform MMT providers to support greater patient comfort with methadone doses and dose changes, as well as adherence to and success in MMT.
    Journal of Addiction Medicine 06/2013; DOI:10.1097/ADM.0b013e318297021e · 1.71 Impact Factor
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