Methadone maintenance therapy and viral suppression among HIV-infected opioid users: The impacts of crack and injection cocaine use

Abstract

Background Methadone maintenance therapy (MMT) is associated with improved HIV treatment outcomes among people who use drugs (PWUD). The extent to which these benefits are sustained in the context of ongoing cocaine use is unclear. We assessed differential impacts of MMT on HIV viral load (VL) suppression in relation to discrete patterns of cocaine use. Methods Data was drawn from ACCESS, a prospective cohort of HIV-positive PWUD in Vancouver, Canada. Generalized linear mixed-effects were used to model the independent effect of MMT on VL suppression across strata of frequency of cocaine injection and crack smoking (≥daily versus <daily), after adjustment for confounders. Results The analysis included 397 HIV-positive opioid users who completed ≥1 study interview between 2005 and 2014. At baseline, 304 (77%) reported participation in MMT, 37 (9%) ≥ daily cocaine injection, and 158 (40%) ≥ daily crack smoking. In adjusted analyses, MMT remained independently associated with increased odds of VL suppression in both strata of crack smokers (AOR=3.11, 95% CI: 1.86–5.21 and AOR=1.48, 95%CI: 1.04–2.09, for ≥daily and <daily smokers, respectively), and among <daily cocaine injectors (AOR=1.88, 95%CI 1.38–2.56), but not among ≥daily cocaine injectors (AOR=1.37, 95%CI 0.53–3.49). Longer retention on MMT was positively associated with VL suppression in all strata of cocaine injection and crack smoke. Conclusions Exposure to MMT was associated with increased odds of VL suppression among HIV- positive opioid users regardless of crack use. However, this beneficial effect of MMT was lost among frequent cocaine injectors with shorter retention on MMT.

Slow-release naltrexone implant versus oral naltrexone for improving treatment outcomes in people with HIV who are addicted to opioids: a double-blind, placebo-controlled, randomised trial

“…However as in the study reported here, there was a positive correlation between continuing addiction treatment and undetectable VL (23). A second study assessed the relationship between undetectable VL (<50 copies per mL) and cocaine use among 304 HIV-infected, methadone maintained opioid/cocaine users in Vancouver, Canada and found that undetectable VL's ranged from 58-70% depending on whether the patient was injecting cocaine less than daily or using crack once or more a day (24). A third study recruited 295 HIV-infected opioid addicted individuals, 176 on ART and 119 not on ART, and started them on sublingual buprenorphine/naloxone (bup/nal).…”

Viral suppression among HIV-infected methadone-maintained patients: The role of ongoing injection drug use and adherence to antiretroviral therapy (ART)

“…Opioid-dependent individuals stabilized on MMT are highly diverse and beyond the benefit of HIV TasP efforts. In the broader literature, several factors have been associated with viral suppression (Aibibula et al, 2018; Arthur et al, 2015; Bowen et al, 2017; Crepaz, Tang, Marks, & Hall, 2017; Ferrand et al, 2016; Socías et al, 2016). Despite substantial research in this area, prior studies have not explored theoretically informed correlates among HIV-infected opioid-dependent patients within drug treatment settings.…”

A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes

“…All 5 studies that analyzed the effect of MOUD on HIV viral suppression reported a significant relationship ( Table 1 ) [ 19 , 22–25 ]. Reddon et al [ 22 ], Roux et al [ 23 ], and Socías et al [ 24 ] reported significant effects of methadone treatment on viral suppression at 6 months. Both studies by Springer et al [ 19 , 25 ] reported viral suppression to be HIV-1 ribonucleic acid (RNA) <50 copies/mL with statistically significant improvement with BPN or XR-NTX.…”