Methadone treatment halves HIV risk

Methadone substitution can significantly reduce the risk for HIV transmission among people who inject opiate drugs, says a team of international researchers.

Georgie MacArthur (University of Bristol, UK) and colleagues conducted the largest review and meta-analysis of published and unpublished data on the relationship between recovery programs and HIV rates.

Writing in the BMJ, they say that their findings support the use of opiate substitution treatment, which is often unavailable in areas with high HIV prevalence.

The analysis included 12 published studies and three unpublished studies, including 1016 incident HIV infections and over 26,738 person-years of follow up. Highlighting a gap in research, methadone was the only substitute treatment for which data were available.

When the authors pooled data from nine of these studies, they found that methadone treatment was associated with a 54% reduction in the risk for HIV infection.

They also noted a weak association between increasing duration of treatment and decreased risk for transmission.

There is substantial evidence that opiate substitution therapies can reduce HIV-risk behaviors among drug users, such as needle-sharing, but the study is the first to quantify the relationship between substitution and HIV transmission.

While the study did not allow the authors to fully explore the reasons for their findings, they say their results are likely due in part to this reduction in risky behaviors. The team also notes that HIV-positive drug users adhere better to antiviral therapy when on substitution treatment - reducing their likelihood of transmitting the virus.

MacArthur and colleagues say that their findings are a call for greater coverage of opiate substitution programs, which are thought to currently reach only 6-12% of injecting drug users.

"These data further support studies showing a range of benefits of opiate substitution treatment, and support calls for the global increase of harm reduction interventions to reduce the transmission of HIV between people who inject drugs and between people who inject drugs and the wider community," they conclude.

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