Abstract
BackgroundMethadone maintenance therapy (MMT) is a proven treatment strategy for opioid dependent patients. Although studies have demonstrated that MMT increases contact with the medical system and improves adherence to antiretroviral therapy (ART) in HIV-positive people who inject drugs (PWID), the effect of MMT discontinuation on ART discontinuation has not been well described.MethodsWe examined the impact of continuous MMT use, MMT non-use and MMT discontinuation on the time to ART discontinuation (defined as 90 days of continuous non-use following previous enrolment) in a community-recruited prospective cohort of HIV-positive PWID followed between May 1996 and May 2013 in Vancouver, Canada. Multivariate Cox proportional hazards regression was used to examine the association between MMT use patterns and time to ART discontinuation while adjusting for socio-demographic confounders.ResultsA total of 794 HIV-positive PWID were included during the study period. In an adjusted analysis, in comparison to those who were continuously on MMT, MMT non-use (Adjusted Hazard Ratio [AHR] = 1.44, 95 % Confidence Interval [CI]: 1.19–1.73) as well as discontinuing MMT (AHR = 1.82, 95 % CI: 1.27–2.60) were both found to be independently associated with time to ART discontinuation.ConclusionsThis study reinforces the known benefits of MMT use on ART adherence and demonstrates how discontinuation of MMT is independently associated with an increased risk of ART cessation. These data highlight the importance of retaining PWID on MMT.
Highlights
Methadone maintenance therapy (MMT) is a proven treatment strategy for opioid dependent patients
Data gathered from the visits is supplemented by information on HIV treatment received from the local province-wide drug treatment program (DTP) at the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE), a centralized antiretroviral therapy (ART) dispensary and HIV laboratory for the province of British Columbia
When we looked at the median plasma HIV viral load throughout study period, the median viral load was less than 50 (IQR: 35–1005) copies/mL among individuals where MMT was used continuously and was 1482 (IQR: 49–39099) copies/mL among individuals who were on but discontinued MMT in the prior six months
Summary
Methadone maintenance therapy (MMT) is a proven treatment strategy for opioid dependent patients. Studies have demonstrated that MMT increases contact with the medical system and improves adherence to antiretroviral therapy (ART) in HIV-positive people who inject drugs (PWID), the effect of MMT discontinuation on ART discontinuation has not been well described. There is a well-documented association between ongoing drug use and decreased ART adherence [7, 8], which can lead to Methadone maintenance therapy (MMT) is an evidence-based approach to treating opioid dependence and reducing illicit opioid use [17]. Enrolment in MMT programs decreases the incidence of ART discontinuation in this population [22] Despite these benefits MMT remains inaccessible in many countries due to local drug regulations, and the five countries with the largest injection-drug driven HIV epidemics provide opioid substitution therapy to less than 2 % of their total populations of PWID [21]
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