The impact of methadone or buprenorphine treatment and ongoing injection on highly active antiretroviral therapy (HAART) adherence: evidence from the MANIF2000 cohort study

Abstract

Both access to and effectiveness of OST contribute to sustaining adherence to HAART in HIV-infected IDUs. These results advocate strongly the need of wider use of OST in countries scaling-up HAART where HIV is driven by IDUs.

Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China

“…These factors have already been well documented in a variety of settings. 14,19,20,[33][34][35] The literature also supports our finding that a low CD4+ cell count at the start of ART is a strong independent predictor of death. 10,12 A low baseline CD4+ cell count, which indicates advanced immunosuppression, is a concern for all patients in China's national ART programme.…”

“…12 Regular, often daily, interactions with health-care providers in the MMT programme: (i) promote the cessation of injecting drug use; (ii) increase adherence to the ART regimen; (iii) ensure regular monitoring of the CD4+ cell count; and (iv) increase opportunities for discussing treatment options, for managing medication side-effects and comorbid conditions and for psychosocial counselling. 20,34,36,37 Thus, the higher CD4+ cell counts we found at ART baseline in patients receiving ART and MMT were not unexpected.…”

“…The lower uptake of ART and the poorer outcomes observed among HIV+ people who inject illicit drugs are thought to be attributable to a variety of factors, such as delays in starting treatment, poor adherence to ART, continuing drug dependence and a high prevalence of comorbidities, such as depression and hepatitis C. 19 Internationally, there is growing evidence that treatment of opioid dependence, such as methadone maintenance treatment (MMT), not only stabilizes drug dependence and its associated psychosocial conditions, but also promotes adherence to ART and improves virological responses among HIV+ people. 18,[20][21][22][23] Although China's national ART and MMT programmes have been shown to benefit their respective target populations when assessed independently, 6,[9][10][11]24,25 the advantages of coincident ART and MMT for HIV+ people who inject opioids have not yet been examined in China, though they have Objective To examine the effect of methadone maintenance treatment (MMT) on mortality in people injecting opioids who receive antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) infection in China. Methods The study involved a nationwide cohort of 23 813 HIV-positive (HIV+) people injecting opioids who received ART between 31 December 2002 and 31 December 2011.…”

“…been observed in other settings. 13,20,23,26,27 The aim of this study, therefore, was to determine whether MMT reduces mortality in HIV+ people who inject opioids and are receiving ART through China's national ART programme.…”

Predictors of Outcome During a 6-Month Follow-Up Among Heroin Dependent Patients Receiving Buprenorphine/Naloxone Maintenance Treatment

“…At a minimum, the findings of the present study may suggest that clinics should review their dosing and monitoring methods. A re-assessment of treatment efficacy through a possible dosage increase or supportive psychosocial programs could potentially increase adherence to BN maintenance treatment 72,73 .…”