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Opioid substitution therapy improves many ART-related outcomes among people who inject drugs
Michael Carter, 2016-07-14 09:00:00
substitution therapy has a key roll in improving antiretroviral therapy
(ART)-related outcomes among HIV-positive people who inject drugs, according
to a systematic review and meta-analysis published in the online edition of Clinical Infectious Diseases. Opioid
substitution therapy was associated with enhanced recruitment to treatment, better
adherence and increased rates or viral suppression. Over 36,000 people were
included in the analysis, but there were limited data from countries with
severe HIV epidemics among people who inject drugs, such as Russia.
review found strong evidence to support the use of OST [opioid substitution therapy] and its inclusion in
routine HIV care for improving the treatment and care continuum amongst
HIV-positive PWID [people who inject drugs],” write the authors. “It supports the need for policy and
health system reforms to accelerate the integration of OST and HIV treatment
Nearly a third of
new HIV infections outside sub-Saharan Africa involve people who inject drugs. The
epidemic in this population is rapidly expanding in Eastern Europe and Central
Asia. Outbreaks of HIV among people who inject drugs have also been observed in
high-prevalence settings, including Kenya and Tanzania.
People who inject
drugs often have poor levels of engagement with HIV care and sub-optimal ART
outcomes. Opioid substitution therapy services have the potential to boost
uptake of ART and retention in care among drug users.
team of investigators pulled together the evidence concerning the impact of
opioid substitution therapy on ART-related outcomes, including recruitment to
treatment, adherence, viral suppression and CD4 cell count increase, stopping treatment
between 1996 and 2014 reporting on these outcomes and involving adults living with HIV who inject drugs were eligible for inclusion. A total of 32
eligible studies involving approximately 36,000 people were identified. These
studies were conducted in nine separate countries. The median duration of
follow-up was 24 months.
reported on ART coverage. Overall, opioid substitution therapy was associated
with a 54% increase in the odds of being on ART (OR, 1.54; 95% CI, 1.17-2.03, p
ART initiation was
reported in four studies, showing that opioid substitution therapy increased
the chances of starting ART by 87% (HR = 1.87; 96% CI, 1.50-2.33, p <
reported on adherence, with opioid substitution therapy associated with a
two-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26, p < 0.001).
was analysed in ten studies, their pooled data showing that use of opioid
substitution therapy increased the odds of achieving suppression (viral low
below 500, 400 or 50 copies/ml) by 45% (OR, 1.45; 95% CI, 1.21-1.73, p <
There was only
modest evidence that opioid substitution therapy had a positive impact on CD4
cell increases. However, longer duration of follow-up was associated with
larger CD4 cell count increases while on opioid substitution therapy.
opioid substitution therapy were significantly less likely to discontinue ART.
Data from the seven studies reporting on this outcome showed that treatment
reduced the odds of stopping ART by 23% (p = 0.01).
reported on the impact of opioid substitution therapy on mortality risk.
Overall, treatment reduced mortality risk by a non-significant 9%.
“We found strong
evidence of a positive impact on most outcomes,” comment the authors.
acknowledge that they had limited data from the several countries with
especially severe epidemics of HIV among people who inject drugs, including
Ukraine, Russia, Malaysia, USA and China.
conclude, “the review provides evidence for the multiple potential benefits of
OST, and its pivotal importance in a combination approach to harm reduction.”