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Injecting Cocaine But Not Smoking Crack Lowers
HIV Control Chance in Methadone Users
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21st International AIDS Conference (AIDS 2016), July 18-22, 2016, Durban, South Africa
Mark Mascolini
Among opioid-dependent people taking antiretroviral therapy (ART), injecting cocaine once or more daily undermined chances that methadone maintenance therapy would promote HIV suppression in a Vancouver group [1]. But in the same group, smoking crack cocaine once or more daily did not affect chances of viral suppression with methadone maintenance.
Opioid-dependent people are more likely to reach an undetectable viral load with ART if they enter a methadone maintenance program. Many HIV-positive people on methadone maintenance also inject cocaine or smoke crack cocaine, but the impact of cocaine on viral control in these people remains poorly understood. To address that question, researchers with the British Columbia Centre for Excellence in HIV/AIDS and other institutions conducted this study.
The researchers mined data from the prospective ACCESS cohort, which began recruiting in 2005 and includes more than 800 HIV-positive drug users in Vancouver. Cohort members have a twice-yearly interview and blood testing. If they test positive for HIV, they get linked to the British Columbia HIV Drug Treatment program.
This analysis focused on ART-exposed opioid users who completed at least one interview from 2005 through 2014. The researchers used generalized linear mixed-effects models to explore the impact of methadone maintenance therapy on viral suppression (a load below 50 copies) with (1) daily or more cocaine injection, or less than daily injection, and (2) daily or more crack cocaine smoking, or less than daily smoking. The models adjusted for age, ethnicity, unstable housing, incarceration, sex work, one or more daily heroin injections, and smoking crack once or more daily.
The analysis involved 397 HIV-positive opioid users taking ART. At the baseline visit the study group had a median age of 41 (interquartile range 36 to 47), 234 participants (59%) were men, and 304 (77%) had been enrolled in a methadone maintenance program in the last 6 months. In the last 6 months 37 study participants (9%) injected cocaine daily or more often and 158 (40%) smoked crack daily or more.
The adjusted analysis indicated that being in methadone maintenance independently raised the odds of viral suppression in people who smoked crack less than daily (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.04 to 2.09, P = 0.028) and in people who smoked crack daily or more often (aOR 3.11, 95% CI 1.86 to 5.21, P < 0.001). Methadone maintenance independently raised odds of viral suppression in people who injected cocaine less than daily (aOR 1.88, 95% CI 1.38 to 2.56, P < 0.001) but not in those who injected daily or more often (aOR 1.37, 95% CI 0.53 to 3.49, P = 0.516).
The Vancouver team believes their findings "support global calls to expand access to low-threshold opioid agonist therapy to improve addiction and HIV outcomes among HIV-positive opioid users." They underlined "the urgent need to identify novel and effective pharmacotherapies for the treatment of cocaine use disorders."
Reference
1. Socias ME, Wood E, Small W, et al. Methadone maintenance therapy and viral suppression among HIV-infected opioid users: the impacts of crack and injection cocaine use. 21st International AIDS Conference (AIDS 2016). July 18-22, 2016. Durban, South Africa. Abstract THPEB093. http://programme.aids2016.org/PAGMaterial/eposters/0_5570.pdf
21st International AIDS Conference (AIDS 2016), July 18-22, 2016, Durban, South Africa
Mark Mascolini
Among opioid-dependent people taking antiretroviral therapy (ART), injecting cocaine once or more daily undermined chances that methadone maintenance therapy would promote HIV suppression in a Vancouver group [1]. But in the same group, smoking crack cocaine once or more daily did not affect chances of viral suppression with methadone maintenance.
Opioid-dependent people are more likely to reach an undetectable viral load with ART if they enter a methadone maintenance program. Many HIV-positive people on methadone maintenance also inject cocaine or smoke crack cocaine, but the impact of cocaine on viral control in these people remains poorly understood. To address that question, researchers with the British Columbia Centre for Excellence in HIV/AIDS and other institutions conducted this study.
The researchers mined data from the prospective ACCESS cohort, which began recruiting in 2005 and includes more than 800 HIV-positive drug users in Vancouver. Cohort members have a twice-yearly interview and blood testing. If they test positive for HIV, they get linked to the British Columbia HIV Drug Treatment program.
This analysis focused on ART-exposed opioid users who completed at least one interview from 2005 through 2014. The researchers used generalized linear mixed-effects models to explore the impact of methadone maintenance therapy on viral suppression (a load below 50 copies) with (1) daily or more cocaine injection, or less than daily injection, and (2) daily or more crack cocaine smoking, or less than daily smoking. The models adjusted for age, ethnicity, unstable housing, incarceration, sex work, one or more daily heroin injections, and smoking crack once or more daily.
The analysis involved 397 HIV-positive opioid users taking ART. At the baseline visit the study group had a median age of 41 (interquartile range 36 to 47), 234 participants (59%) were men, and 304 (77%) had been enrolled in a methadone maintenance program in the last 6 months. In the last 6 months 37 study participants (9%) injected cocaine daily or more often and 158 (40%) smoked crack daily or more.
The adjusted analysis indicated that being in methadone maintenance independently raised the odds of viral suppression in people who smoked crack less than daily (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.04 to 2.09, P = 0.028) and in people who smoked crack daily or more often (aOR 3.11, 95% CI 1.86 to 5.21, P < 0.001). Methadone maintenance independently raised odds of viral suppression in people who injected cocaine less than daily (aOR 1.88, 95% CI 1.38 to 2.56, P < 0.001) but not in those who injected daily or more often (aOR 1.37, 95% CI 0.53 to 3.49, P = 0.516).
The Vancouver team believes their findings "support global calls to expand access to low-threshold opioid agonist therapy to improve addiction and HIV outcomes among HIV-positive opioid users." They underlined "the urgent need to identify novel and effective pharmacotherapies for the treatment of cocaine use disorders."
Reference
1. Socias ME, Wood E, Small W, et al. Methadone maintenance therapy and viral suppression among HIV-infected opioid users: the impacts of crack and injection cocaine use. 21st International AIDS Conference (AIDS 2016). July 18-22, 2016. Durban, South Africa. Abstract THPEB093. http://programme.aids2016.org/PAGMaterial/eposters/0_5570.pdf
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