Reduced HIV Viral Suppression Among Methadone-Maintained Patients
A subset of methadone-maintained patients face unaddressed HIV-related treatment challenges. Photo credit: CDC/ Maureen Metcalfe, Tom Hodge
Although methadone maintenance therapy (MMT) has been shown to enhance access and adherence with antiretroviral therapy (ART), a subset of people receiving methadone maintenance have unaddressed HIV-related treatment challenges, according to a recently published study in Addictive Behaviors.
From 2012 to 2018, 133 participants with HIV infection and opioid-dependence who reported drug- or sex-related risk behavior in the previous 6 months were enrolled from a methadone maintenance drug treatment facility in New Haven, Connecticut (ClinicalTrials.gov identifier: NCT01741311). Viral load and CD4 cell counts were collected. Participants' adherence with ART and other variables were assessed using an audiocomputer-assisted self-interview. Multivariable logistic regression was used to identify significant correlates of viral suppression.
Of the 91% of participants taking ART, 57.9% achieved optimal adherence and 80.4% achieved viral suppression (<200 copies/mL). Self-reported HIV risk behaviors were highly prevalent, as 46.6% of participants reported injecting illicit drugs in the previous 30 days. Of those, 58.1% reported having shared injection equipment. Furthermore, 21.1% reported having sex with >1 sexual partner, and only 14.3% reported always using condoms in the previous 30 days.
Results showed that longer HIV diagnosis (P <.038), being employed (P <.041), and having optimal ART adherence (P <.008) were all factors associated with viral suppression. Furthermore, having optimal adherence with ART was associated with more than 4-fold odds (P =.009) and having high CD4 count (≥500 cells/mm3) was associated with 2-fold odds of achieving viral suppression (P =.045).
Additionally, participants who reported having injected drugs during the previous 30 days were significantly less likely to achieve viral suppression (P =.036). A significant interaction effect was found involving optimal ART adherence and injection of drugs on viral suppression (P =.029).
Overall, 1 in 5 participants was unable to achieve viral suppression, although MMT has previously been shown to enhance access and adherence with ART and sustained viral suppression. Optimal ART adherence effect on viral suppression was reduced because of ongoing injection drug use practices.
The study authors conclude that, “our findings illustrated how the benefit of MMT programs may be negated among a significant segment of methadone-maintained patients and highlights unaddressed HIV-related treatment challenges faced by this risk group.”
Shrestha R, Copenhaver MM. Viral suppression among HIV-infected methadone-maintained patients: the role of ongoing injection drug use and adherence to antiretroviral therapy (ART). Addict Behav. 2018;85:88-93.