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Treating addictions would improve adherence to HIV treatment

Picture of Tina Gutiérrez
Tina Gutiérrez

Providing people who inject drugs with substitution therapy would make it easier to integrate those who are also living with HIV into treatment. Injecting drug users are a key population in the response to this epidemic, as the virus is often transmitted between them by sharing injection equipment.

In addition, it is a group that is especially vulnerable to discrimination, since prejudices about their behavior persist. Added to this is that most of these people do not have very defined routines, nor do they usually have a fixed residence or enough income to cover their needs, explains the Working Group on HIV Treatments (gTt-HIV).

Substance substitution

Substitution therapy is treatment in which opioid medications, such as methadone, are given to people who want to stop using illegal drugs. In this way, withdrawal syndrome is prevented and the risk of relapse in consumption is reduced.

Also, the therapy in question makes it easier for people to stop using drugs, so that they regain their lives and control over their health.

A group of researchers from the Center on Substance Use in British Columbia, Canada, wanted to assess the impact that this substitution therapy would have on the control of HIV infection in the population of injection drug users.

The study

According to the authors, about 40% of people who inject drugs in the city in the province of British Columbia are living with HIV.

There is a substitution therapy program that is operated by specialized community clinics. Until 2010, the program only provided methadone, and from that year the combination buprenorphine / naloxone was added. Then, beginning in 2017, oral morphine and diacetylmorphine (also known as medicinal heroin) and intravenous hydromorphone were included.

The research, published in the medical journal AIDS, included 639 people with HIV who used intravenous opioids daily. The study was carried out between 2005 and 2017.

59% of the people were men, 56% were white, and the average age was 42 years. In addition, more than 90% also had the hepatitis C virus. 70% of the participants were on opioid substitution therapy, most with methadone.

The authors observed that the percentage of people on opioid substitution therapy who remained in adequate medical follow-up was higher than that observed in people who did not have the same therapy, although the difference was not statistically significant (96% vs. 93%, respectively).

But when looking at the specific data of the percentage of people who took antiretroviral drugs, those who took substitution therapy did so much more than those who were not on that therapy (77% vs. 54%, respectively).

The balance tipped in the same direction for undetectable viral load, that is, HIV control so efficient that the amount of virus in the blood is too small to be measured. In this case, 63% of people on substitution therapy had an undetectable viral load, compared to 42% of those who did not have the therapy.

The probability that drug users were on antiretroviral treatment was also studied, and it was observed that those who were on substitution therapy were four times more likely than those who did not have that therapy.

Likewise, the probability of having a good adherence to treatment was triple in people on therapy than in people without therapy, and the probability of having an undetectable viral load was double in those on therapy.

These results, say the researchers, highlight the importance of having a good health care system for people who use drugs, which can prescribe and deliver substitution therapy.

Regardless of a person’s lifestyle, if they are living with HIV it is essential that they receive treatment to control the infection. If you or someone you know wants to take a free HIV test, at AHF Latin America and the Caribbean we do it. Find our closest office to you, we are in 11 countries in the region.