Researchers in Vancouver, British Columbia, have found that the treatment of HIV positive substance users is challenging for the following reasons:
The research team, led by Dr. Stanley de Vlaming and colleagues, established a methadone-maintenance programme, in which subjects were given both methadone and highly active antiretroviral therapy (HAART) daily. PHAs in this programme were observed directly by a pharmacist as they took their medications.
Researchers enrolled 52 subjects who had the following profile at the start of the study:
Subjects were monitored for about 1½ years. They received either a once-daily or twice-daily combination of anti-HIV drugs. The following were the most commonly used combinations:
During the study, 64% of subjects continued to use recreational drugs, including cocaine. Based on the type of regimen used, on average, CD4+ counts increased to the following levels:
This difference between the two regimens was not statistically significant.
Subjects given nevirapine developed significantly higher CD4+ counts (an average of 483 cells) compared to those taking PI-based regimens (an average of 319 cells).
The proportion of subjects in each group who achieved a viral load of fewer than 400 copies was as follows:
This difference was not statistically significant. Using the more sensitive viral load test that measures down to 50 copies, the proportion of subjects in each group who achieved a viral load of fewer than 50 copies was as follows:
Again, this difference between the two regimens was not statistically significant.
Although most subjects continued to use cocaine while in the study, 60% of cocaine users were able to achieve a viral load of fewer than 400 copies. Thirty-one subjects needed to have their methadone dosage adjusted during the study. No severe liver damage was detected, which is remarkable given that co-infection with hepatitis-causing viruses is common among substance users.
The results of this study show that directly observed therapy (DOT) may be useful for the combination of addiction and HIV treatment.
REFERENCE
Conway B, Prasad J, Smith N and de Vlaming S. Once-daily directly observed therapy (DOT) for management of HIV-infected individuals in a methadone program. Poster 1917 - 41st annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Chicago, 16–19 December 2001.
20020131
CATE12405
Copyright © 2002 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2002. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.