Virological Success for HIV-Infected Injection Drug Users Receiving Antiretroviral Treatment.

Virological Success for HIV-Infected Injection Drug Users Receiving Antiretroviral Treatment.

The positive impact of opioid substitution treatment on opioid-dependent individuals with human immunodeficiency virus (HIV) infection is well documented, especially with regard to adherence to antiretroviral therapy. Roux et al used the data from a 5-year longitudinal study of the MANIF 2000 cohort of individuals infected with HIV (as a result of injection drug use) and receiving ART to investigate the predictors of long-term virological success. Data were collected every 6 months from outpatient hospital services delivering HIV care in France. The authors selected all patients who were receiving antiretroviral therapy for at least 6 months (baseline visit) and who had indications for opioid substitution treatment (ie, still dependent on opioids). They selected a total of 113 patients, accounting for a total of 562 visits for all the analyses. Long-term virological success was defined as an undetectable viral load after at least 6 months on antiretroviral therapy. Retention in opioid substitution treatment was defined as the time interval between the last initiation or reinitiation of opioid substitution treatment during antiretroviral therapy follow-up and any given visit on opioid substitution treatment. A mixed logistic model was used to identify predictors of long-term virological success. At baseline, 53 patients were receiving buprenorphine, 28 patients were receiving methadone, and 32 patients were not on opioid substitution treatment. The median duration of opioid substitution treatment was 25 months (range, 3-42 months). In the multivariate analysis, after adjustment for significant predictors of long-term virological success such as adherence to antiretroviral therapy and early virological response, retention in opioid substitution treatment was associated with long-term virological success (odds ratio, 1.20 per 6-month increase; 95% confidence interval, 1.09-1.32). The study presents important evidence of the positive impact of retention in opioid substitution treatment on HIV outcomes. Increasing access to opioid substitution treatment based on a comprehensive model of care for HIV-infected patients who have indications for opioid substitution treatment may foster adherence and ensure long-term response to antiretroviral therapy.

Editors’ note: Although people who inject drugs and who adhere to antiretroviral treatment have similar HIV outcomes to people who do not inject drugs, physicians may deny or delay initiation of antiretroviral treatment to active drug users. This is the first study to show that retention in opioid substitution treatment contributes to long-term virological suppression in injecting drug users on antiretroviral treatment. Expanded access to opioid substitutes, in the context of comprehensive care, is known to reduce the use of nonsterile injecting equipment and to increase consistent condom use. Given that opioid substitutes are included in the WHO list of essential medicines, the virological outcomes reported here give added impetus to initiatives to increase access to opioid substitution treatment for people living with HIV who inject drugs.