Fifth International Congress Drug Therapy in HIV Infection 22-26 October, 2000 Glasgow, UK

Antiviral therapy and management of HIV in intravenous drug users

F. Mulcahy
Department of Genito-Urinary Medicine and Infectious Diseases, St. James’ Hospital, Dublin, Ireland

Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No. PL3.3
AIDS 2000, Oct 22-26;14(Suppl. 4);S2

Antiretroviral therapy (ART) is the standard of care for all patients with HIV infection. However physicians are less likely to prescribe such treatment to drug users (DUs) than to any other risk group. This is in part linked to a belief that DUs are less adherent to complex regimens. Studies have shown that only 40% of DUs eligible for ART are receiving it. Of these, however, only 37% approximately are 80 % adherent. Consequently DUs are poorly represented in all major clinical trials. In addition, there is a risk of major drug interactions in DUs on ART both with prescribed and illicit drugs. Studies and case reports have demonstrated that drugs which are inhibitors or inducers of CYP450 isoenzymes alter the metabolism of methadone. A significant interaction between Methadone and Non-Nucloside reverse Transcriptase Inhibitor (NNRTIs) i.e. efavirenz and nevirapine, leading tomethadone withdrawal indicated by enzyme induction has been studied. Methadone AUC_0–24h was reduced was over 50% with a requirement for methadone dose increases of approximately 20%. Nelfinavir has also been associated with methadone withdrawal symptoms. Further interactions with antiretrovirals are being evaluated.

The management of HIV infection is therefore both complex and challenging. Options include linking ART with daily observed methadone maintenance therapy, choosing simple once or twice daily regimens anticipating and treating drug interactions and consistent patient evaluation at combined addiction/ medical trials.

Presenting author: F. Mulcahy

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2000-10-22
PL3-3

Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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