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The Impact of Methadone or Buprenorphine Treatment and Ongoing Injection on Highly Active Antiretroviral Therapy (HAART) Adherence: Evidence from the MANIF2000 Cohort Study

November 4, 2008

"To date, no data exist assessing the impact of either methadone or buprenorphine on adherence to highly active antiretroviral therapy (HAART) in the long term," the authors wrote. They designed the current study to determine whether receiving take-home methadone and buprenorphine may ensure better adherence to HAART in patients who contracted HIV through injection drug use (IDU). The researchers collected longitudinal data on adherence, opioid substitution treatment (OST), and patient behaviors beginning with their first HAART prescription. (Patients=276; visits=1,558). The setting was outpatient hospital facilities delivering HIV care in Marseilles, Avignon, Nice, and Ile de France.

At their visits, patients were classified according to the type of OST they received and ongoing injection. Those patients who reported neither injection nor OST during the entire period were classified as abstinent and used as a reference category. A logit model based on generalized estimation equations was used to identify non-adherence predictors.

Patients who stopped injecting during OST and abstinent patients evidenced comparable adherence, after adjustments were made for alcohol consumption, depression, and self-reported side effects. Compared with abstinent patients, patients who reported drug injection, on OST or not, had a two-fold or three-fold risk, respectively, of non-adherence (P<0.01 linear trend). Length of time on OST without IDU was significantly associated with virological success.

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

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Adapted from:
11.2008; Vol. 103; No. 11: DOI: 10.1111/j.1360-0443.2008.02323.x; Perrine Roux, M. Patrizia Carrieri, Virgine Villes, Pierre Dellamonica, Isabelle Poizot-Martin, Isabelle Ravaux, Bruno Spire

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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