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Observational Study
. 2015 Aug;110(8):1330-9.
doi: 10.1111/add.12970.

Dose-response relationship between methadone dose and adherence to antiretroviral therapy among HIV-positive people who use illicit opioids

Leslie Lappalainen  1   2 , Seonaid Nolan  1   3 , Sabina Dobrer  1 , Cathy Puscas  1   4 , Julio Montaner  1   3 , Keith Ahamad  1   2 , Huiru Dong  1 , Thomas Kerr  1   3 , Evan Wood  1   3 , M-J Milloy  1   3
Affiliations
Observational Study

Dose-response relationship between methadone dose and adherence to antiretroviral therapy among HIV-positive people who use illicit opioids

Leslie Lappalainen et al. Addiction. 2015 Aug.

Abstract

Background and aims: For HIV-positive individuals who use illicit opioids, engagement in methadone maintenance therapy (MMT) can contribute to improved HIV treatment outcomes. However, to our knowledge, the role of methadone dosing in adherence to antiretroviral therapy (ART) has not yet been investigated. We sought to examine the relationship between methadone dose and ART adherence among a cohort of people who use illicit opioids.

Design and setting: We used data from the AIDS Care Cohort to Evaluate Access to Survival Services (ACCESS) study, an ongoing prospective observational cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, linked confidentially to comprehensive HIV treatment data in a setting of universal no-cost medical care, including medications. We evaluated the longitudinal relationship between methadone dose and the likelihood of ≥ 95% adherence to ART among ART-exposed participants during periods of engagement in MMT.

Participants: Two hundred and ninety-seven ART-exposed individuals on MMT were recruited between December 2005 and May 2013 and followed for a median of 42.1 months.

Measurements: We measured methadone dose at ≥ 100 versus < 100 mg/day and the likelihood of ≥ 95% adherence to ART.

Findings: In adjusted generalized estimating equation (GEE) analyses, MMT dose ≥ 100 mg/day was associated independently with optimal adherence to ART [adjusted odds ratio (AOR) = 1.38; 95% confidence interval (CI) = 1.08-1.77). In a subanalysis, we observed a dose-response relationship between increasing MMT dose and ART adherence (AOR = 1.06 per 20 mg/day increase, 95% CI = 1.00-1.12).

Conclusion: Among HIV-positive individuals in methadone maintenance therapy, those receiving higher doses of methadone (≥ 100 mg/day) are more likely to achieve ≥ 95% adherence to antiretroviral therapy than those receiving lower doses.

Keywords: Adherence; HIV; antiretroviral therapy; illicit drug use; methadone; opioid.

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Figures

Figure 1
Figure 1
Proportion with 95% confidence intervals of individuals achieving at least 95% adherence to antiretroviral therapy in the previous six months at baseline stratified by methadone dose (n = 297). Cochran-Armitage test for trend: p-value = 0.021
See this image and copyright information in PMC

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