[WeOaLB0202] Directly administered antiretroviral therapy (DAART) in conjunction with methadone is associated with improved HIV treatment outcomes in HIV-infected injection drug users (IDUs)

3rd International AIDS Society Conference on HIV Pathogenesis and Treatment

Rio de Janeiro - July 24 - 27, 2005

DIRECTLY ADMINISTERED ANTIRETROVIRAL THERAPY (DAART) IN CONJUNCTION WITH METHADONE IS ASSOCIATED WITH IMPROVED HIV TREATMENT OUTCOMES IN HIV-INFECTED INJECTION DRUG USERS (IDUS)

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WeOaLB0202

Lucas G.M.¹, Mullen B.A.¹, Weidle P.J.², Hader S.², Moore R.D.¹
¹Johns Hopkins University School of Medicine, Baltimore, MD, United States, ²Centers for Disease Control and Prevention, Atlanta, GA, United States

INTRODUCTION: To assess the efficacy of DAART in the treatment of HIV-infected IDUs in methadone clinics.

METHODS: Eligible HIV-infected IDUs at 3 methadone clinics in Baltimore, MD were enrolled in a prospective study of DAART. Morning doses of ART were taken under supervision on weekdays and other doses were pre-packaged and self-administered. Three groups of concurrent comparison patients who took ART on a self-administered basis were selected from the Johns Hopkins HIV Cohort: 1) IDUs who were receiving methadone therapy [IDU(+)meth], 2) IDUs who were not receiving methadone [IDU(-)meth], and 3) non-IDUs. DAART participants and controls were excluded if they had documented triple-class drug resistance prior to starting therapy. HIV RNA <400 c/ml was compared in the groups by ITT (M=F). Logistic regression was used to control for potential confounders.

RESULTS: 88 subjects participated in DAART, and 91 IDU (+) meth, 302 IDU (-) meth, and 662 non-IDU comparison patients were selected. By 6 months, 74% of DAART participants achieved HIV RNA <400 c/ml compared to 45% in the IDU (+) meth group (P<0.001), 53% in the IDU (-) meth group (P=0.001), and 63% in non-IDUs (P=0.05). Median increases in CD4 cell count at 6 months were +74 in DAART, +22 in IDU (+) meth, +26 in IDU (-) meth, and +50 in non-IDUs. In a multivariate logistic regression model (adjusting for age, baseline viral load, prior ART exposure, and regimen type), patients in the comparison groups were significantly less likely to achieve HIV RNA <400 c/m1 at 6 months than DAART participants (odds ratio [OR] 0.3 for the IDU (+) meth group, OR 0.4 for the IDU (-) meth group, and OR 0.6 for the non-IDU group, P,0.05 all comparisons).

CONCLUSIONS: The results of this study strongly suggest that DAART, in the framework of methadone therapy, is associated with clinically-meaningful improvements in treatment outcomes in HIV-infected IDUs. Additional studies of this intervention are indicated.

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