People with HIV who inject drugs benefit most from integrated treatment, study finds

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While antiretroviral treatment and opioid substitution therapy (methadone, for example) each increase survival rates among people who inject drugs and live with HIV, the two treatments lower risks of dying from all causes, including those stemming from drug use and HIV, most effectively when both are available at the same time, a study reported in Clinical Infectious Diseases has found. The study, led by Bohdan Nosyk of BC Centre for Excellence in HIV/AIDS in Vancouver, used pharmaceutical and vital statistics databases, along with treatment records to follow outcomes for patients accessing opioid substitution treatment and diagnosed with HIV.

An estimated 1.7 million to 3 million people who inject drugs live with HIV. Comprising from 5 to 10 percent of everyone living with the virus worldwide, they face compounded risks including drug overdose, hepatitis C infection, and obstacles to consistent antiretroviral treatment that greatly lower survival rates. Addressing the health, and healthcare access challenges confronting people who inject drugs, particularly those living with HIV is critical, to overall success in defeating HIV globally, UNAIDS 2014 Gap Report stressed, noting that exponential increases in HIV infection follow the arrival of injecting drugs in communities.

Among the findings of The Effects of Opioid Substitution Treatment and Highly Active Antiretroviral Therapy on the Cause-Specific Risk of Mortality Among HIV-Positive People Who Inject Drugs, including that people receiving only opioid substitution therapy had slightly lower death risks that those receiving only antiretroviral treatment, were ones pointing to the immediate impacts of addressing drug addiction. The sum of the impact of the two treatments together, though, researchers found, was “substantially stronger” than their individual impacts. Among the limitations of the study the authors note, was the greater accessibility to both treatments, and to health care in the British Columbia setting than in many other settings facing combined epidemics of injecting drug use and HIV.

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