• Once-Daily vs. Twice-Daily Directly Observed Therapy (DOT) for Management of HIV-Infected Individuals in a Methadone (MET) Program
  Abstract 1917
  Authored by B. Conway (University of British Columbia, Vancouver, BC, Canada), S. De Vlaming (St. Paul's Hospital, Vancouver, BC, Canada)
  View the original abstract

Treating HIV is difficult under any circumstances; however, in methadone patients, it is even more complex. This is a study of directly observed HIV therapy given with methadone once or twice per day. There were 52 patients in the study. Patients who were on twice-daily regimens took their second dose on their own in the evenings. All patients also had hepatitis C infection -- which is nearly universal in methadone clinics. Baseline CD4 count was 202 and mean plasma viral load was 215,000 copies. Twenty-nine patients received once-daily regimens (15 NVP/3TC/ddI, 8 RTV/SQV/3TC/ddI, and 6 others). Twenty-three patients received twice-daily regimens including NNRTIs, PIs and nucleosides.

After 18 months follow up, 63 percent had HIV levels of 400 copies including 64 percent who were still using recreational drugs. There was no difference in the CD4 count (390 vs. 357) or HIV viral loads between the once and twice-daily regimens. Patients taking NVP vs. PIs had similar virologic responses but the NVP patients had a significantly higher CD4 count: 483 vs. 319. There was no grade 3 or 4 liver toxicity in any of the patients, which was surprising in light of the fact that all patients had hepatitis C.

This is a study that demonstrates that directly observed therapy works in methadone clinics even if drug use continues. Good virologic responses were found and the liver toxicity of HIV medications was not a problem even in the face of hepatitis C.

Considering all the bad press NVP has been receiving lately for liver toxicity (which, in my opinion, is undeserved), this is a study that is quite positive in two ways. Not only did the NVP work well raising CD4 counts but there was no serious liver toxicity in these drug-using hepatitis C patients. The extra CD4 response found in the NVP patients is interesting and is undergoing further study. Good news for the methadone crowd and their livers!