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. 2010 May;105(5):907-13.
doi: 10.1111/j.1360-0443.2010.02905.x. Epub 2010 Mar 10.

Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users

Sasha Uhlmann  1 , M-J Milloy, Thomas Kerr, Ruth Zhang, Silvia Guillemi, David Marsh, Robert S Hogg, Julio S G Montaner, Evan Wood
Affiliations

Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users

Sasha Uhlmann et al. Addiction. 2010 May.

Abstract

Aims: Despite proven benefits of antiretroviral therapy (ART), many human immunodeficiency virus (HIV)-infected injection drug users (IDU) do not access treatment even in settings with free health care. We examined whether methadone maintenance therapy (MMT) increased initiation and adherence to ART among an IDU population with free health care.

Design: We examined prospectively a cohort of opioid-using antiretroviral-naive HIV-infected IDU and investigated factors associated with initiation of antiretroviral therapy as well as subsequent adherence. Factors associated independently with time to first initiation of antiretroviral therapy were modelled using Cox proportional hazards regression.

Findings: Between May 1996 and April 2008, 231 antiretroviral-naive HIV-infected opioid-using IDU were enrolled, among whom 152 (65.8%) initiated ART, for an incidence density of 30.5 [95% confidence interval (CI): 25.9-35.6] per 100 person-years. After adjustment for time-updated clinical characteristics and other potential confounders, use of MMT was associated independently with more rapid uptake of antiretroviral therapy [relative hazard = 1.62 (95% CI: 1.15-2.28); P = 0.006]. Those prescribed methadone also had higher rates of ART adherence after first antiretroviral initiation [odds ratio = 1.49 (95% CI: 1.07-2.08); P = 0.019].

Conclusion: These results demonstrate that MMT contributes to more rapid initiation and subsequent adherence to ART among opioid-using HIV-infected IDU. Addressing international barriers to the use and availability of methadone may increase dramatically uptake of HIV treatment among this population.

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Figures

Figure 1
Figure 1
Time to antiretroviral therapy (ART) initiation among a prospective cohort of HIV-infected injection drug users, stratified by baseline enrolment in methadone maintenance therapy (MMT).
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