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The Body Covers: The 12th International AIDS Conference

Can Antiretroviral Therapy Be Delivered in a Methadone Maintenance Setting?

Coverage provided by Ian Frank, M.D.

July 2, 1998

Many practitioners hesitate to prescribe triple combination antiretroviral therapy to individuals with histories of illicit drug use and individuals in methadone maintenance programs because of the bias that these patients will not be able or willing to adhere to the pill taking schedule. The assumption is that poor adherence will lead to resistance and treatment failure. A group in Switzerland studied 51 patients in four methadone maintenance programs. All patients received ddI once daily and d4T and nelfinavir administered twice-a-day. Partially observed therapy was given, with one dose of each drug given together with methadone. Viral load and CD4+ count changes were measured together with a quality of life assessment.

Three patients were lost to follow-up, two refused to have blood taken for monitoring, and two stopped participation due to lack of adherence. However, the remaining patients faired well. 70% of patients said they took 90% of their medication, a fact confirmed by pill counts. Mean viral load reductions of approximately 2.0 log10 copies/mL were observed after 24 weeks of therapy, and CD4+ counts rose, on average, by over 200 cells/mm3. Further interest was provided by the quality of life measurements. Patients on antiretroviral therapy felt that their health and functioning were improved; they felt that they experienced less pain; and their energy was improved. Thus, antiretroviral therapy led to an improved sense of well being in these individuals.

This study provides encouragment that antiretroviral therapy can be provided in methadone maintenance settings with good results. More studies are needed to assess the challenges of providing therapy to this patient population, and longer periods of follow-up are needed to see if the favorable experience of this group can be continued over time.

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