People with HIV receiving methadone and HIV drugs spend less time with detectable viral load

People on methadone maintenance treatment spent less time
with a detectable viral load above 1500 copies/ml, potentially reducing the
risk of HIV transmission, a study presented at last month’s 22nd
International AIDS Conference has found.

Methadone is an opioid substitution treatment prescribed to
minimise the harms associated with the use of heroin or other opioids. Methadone maintenance treatment also promotes
improved adherence to antiretroviral treatment and retention in care in people
living with HIV who use drugs. Buprenorphine, an alternative to methadone, is widely prescribed in France and North America.

Although the use of methadone maintenance treatment is known
to reduce the incidence of HIV in people who use drugs by reducing the
frequency of injecting, it is not known whether, by influencing adherence and
care-seeking behaviour, methadone maintenance treatment has an impact on virological

To answer this question, researchers from the British
Columbia Centre on Substance Use looked at the relationship between the time
spent accessing methadone-maintenance treatment through low-threshold
facilities – those that make it as easy as possible for drug users to obtain
methadone – and the time spent with a viral load above 1500 copies/ml.

Having a viral load above 1500 copies/ml is associated with
an increased risk of HIV transmission to sexual partners. The viral load
threshold at which the risk of HIV transmission through shared injecting
equipment increases is not known, so the level of 1500 copies/ml used in this
study is an assumption.

The study population was drawn from a British Columbia
cohort, the AIDS Care Cohort to Evaluate Access to Survival Services (ACCESS),
of people living with HIV who use illicit drugs. All participants in the cohort
study taking antiretroviral therapy were eligible for inclusion in this
analysis if they had at least two viral load measurements. Viral load was
routinely sampled every six months. These measurements were linked to
antiretroviral prescription dispensing records and to self-reports of methadone

The study population comprised 867 people who use drugs in
care between 2005 and 2017. The study accumulated 4532 person-years of
follow-up; during this period 60% of participants received methadone
maintenance treatment for at least some of the time. Sixty-three per cent of
the study population was male.

During the study period, 67% of the sample had at least one
period of viral load over 1500 copies/ml and on average, spent 19% of the observation
time with a viral load above 1500 copies/ml. Engagement in methadone
maintenance therapy was independently associated with a reduced risk of time
spent with a viral load above 1500 copies/ml: people who received methadone
were 30% less likely to have a viral load above 1500 copies/ml at any point
during the study period (adjusted hazard 0.70, 95% CI 0.60-0.81, p<0.001).

Presenting the findings, Brittany Barker, a PhD candidate at
the University of British Columbia, said that methadone maintenance treatment
is a key intervention for reducing onward HIV transmission in the community and
that the group’s findings support the scale-up of evidence-based addiction
care, including the reduction of barriers to methadone or buprenorphine
prescribing by non-specialist physicians.

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