Directly Administered Antiretroviral Therapy in Methadone Clinics Is Associated with Improved HIV Treatment Outcomes, Compared with Outcomes among Concurrent Comparison Groups
Background. Directly administered antiretroviral therapy (DAART) in methadone clinics has the potential to improve treatment outcomes for human immunodeficiency virus (HIV)—infected injection drug users (IDUs). Methods. DAART was provided at 3 urban methadone clinics. Eighty-two participants who wer...
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| Veröffentlicht in: | Clinical infectious diseases 2006-06, Vol.42 (11), p.1628-1635 |
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| creator | Lucas, Gregory M. Mullen, B. Anna Weidle, Paul J. Hader, Shannon McCaul, Mary E. Moore, Richard D. |
| description | Background. Directly administered antiretroviral therapy (DAART) in methadone clinics has the potential to improve treatment outcomes for human immunodeficiency virus (HIV)—infected injection drug users (IDUs). Methods. DAART was provided at 3 urban methadone clinics. Eighty-two participants who were initiating or reinitiating highly active antiretroviral therapy (HAART) received supervised doses of therapy at the clinic on the mornings on which they received methadone. Treatment outcomes in the DAART group were compared with outcomes in 3 groups of concurrent comparison patients, who were drawn from the Johns Hopkins HIV Cohort. The concurrent comparison patients were taking HAART on a self-administered basis. The 3 groups of concurrent comparison patients were as follows: patients with a history of IDU who were receiving methadone at the time HAART was used (the IDU-methadone group; 75 patients), patients with a history of IDU who were not receiving methadone at the time that HAART was used (the IDU-nonmethadone group; 244 patients), and patients with no history of IDU (the non-IDU group; 490 patients). Results. At 12 months, 56% of DAART participants achieved an HIV type 1 RNA level |
| doi_str_mv | 10.1086/503905 |
| format | Article |
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Anna ; Weidle, Paul J. ; Hader, Shannon ; McCaul, Mary E. ; Moore, Richard D.</creator><creatorcontrib>Lucas, Gregory M. ; Mullen, B. Anna ; Weidle, Paul J. ; Hader, Shannon ; McCaul, Mary E. ; Moore, Richard D.</creatorcontrib><description>Background. Directly administered antiretroviral therapy (DAART) in methadone clinics has the potential to improve treatment outcomes for human immunodeficiency virus (HIV)—infected injection drug users (IDUs). Methods. DAART was provided at 3 urban methadone clinics. Eighty-two participants who were initiating or reinitiating highly active antiretroviral therapy (HAART) received supervised doses of therapy at the clinic on the mornings on which they received methadone. Treatment outcomes in the DAART group were compared with outcomes in 3 groups of concurrent comparison patients, who were drawn from the Johns Hopkins HIV Cohort. The concurrent comparison patients were taking HAART on a self-administered basis. The 3 groups of concurrent comparison patients were as follows: patients with a history of IDU who were receiving methadone at the time HAART was used (the IDU-methadone group; 75 patients), patients with a history of IDU who were not receiving methadone at the time that HAART was used (the IDU-nonmethadone group; 244 patients), and patients with no history of IDU (the non-IDU group; 490 patients). Results. At 12 months, 56% of DAART participants achieved an HIV type 1 RNA level <400 copies/mL, compared with 32% of participants in the IDU-methadone group (P = .009), 33% of those in the IDU-nonmethadone group (P = .001), and 44% of those in the non-IDU group (P = .077). The DAART group experienced a median increase in the CD4 cell count of 74 cells/mm3, compared with 21 cells/mm3 in the IDU-methadone group (P = .04), 33 cells/mm3 in the IDU-nonmethadone group (P = .09), and 84 cells/mm3 in the non-IDU group (P = .98). After adjustment for other covariates in a logistic regression model, DAART participants were significantly more likely to achieve viral suppression than were patients in each of the 3 comparison groups. Conclusions. These results suggest that methadone clinic—based DAART has the potential to provide substantial clinical benefit for HIV-infected IDUs.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/503905</identifier><identifier>PMID: 16652321</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Adult ; AIDS ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - therapeutic use ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active ; Antiretrovirals ; Antiviral agents ; Antivirals ; Biological and medical sciences ; CD4 Lymphocyte Count ; Directly Observed Therapy ; Female ; Health outcomes ; Highly active antiretroviral therapy ; HIV ; HIV 1 ; HIV Infections - drug therapy ; HIV/AIDS ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious diseases ; Injections ; Male ; Medical sciences ; Methadone ; Methadone - therapeutic use ; Middle Aged ; Pharmacology. Drug treatments ; RNA ; RNA, Viral - blood ; Substance abuse treatment ; Substance Abuse, Intravenous - rehabilitation ; Time Factors ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Viral Load</subject><ispartof>Clinical infectious diseases, 2006-06, Vol.42 (11), p.1628-1635</ispartof><rights>Copyright 2006 The Infectious Diseases Society of America</rights><rights>2006 by the Infectious Diseases Society of America 2006</rights><rights>2006 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Jun 1, 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-2b4efd60727a5b9ba59ca2fe3d770522c204a3bb9c22f115c6a015a1e51ecb663</citedby><cites>FETCH-LOGICAL-c451t-2b4efd60727a5b9ba59ca2fe3d770522c204a3bb9c22f115c6a015a1e51ecb663</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/4484801$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/4484801$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17923805$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16652321$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lucas, Gregory M.</creatorcontrib><creatorcontrib>Mullen, B. Anna</creatorcontrib><creatorcontrib>Weidle, Paul J.</creatorcontrib><creatorcontrib>Hader, Shannon</creatorcontrib><creatorcontrib>McCaul, Mary E.</creatorcontrib><creatorcontrib>Moore, Richard D.</creatorcontrib><title>Directly Administered Antiretroviral Therapy in Methadone Clinics Is Associated with Improved HIV Treatment Outcomes, Compared with Outcomes among Concurrent Comparison Groups</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. Directly administered antiretroviral therapy (DAART) in methadone clinics has the potential to improve treatment outcomes for human immunodeficiency virus (HIV)—infected injection drug users (IDUs). Methods. DAART was provided at 3 urban methadone clinics. Eighty-two participants who were initiating or reinitiating highly active antiretroviral therapy (HAART) received supervised doses of therapy at the clinic on the mornings on which they received methadone. Treatment outcomes in the DAART group were compared with outcomes in 3 groups of concurrent comparison patients, who were drawn from the Johns Hopkins HIV Cohort. The concurrent comparison patients were taking HAART on a self-administered basis. The 3 groups of concurrent comparison patients were as follows: patients with a history of IDU who were receiving methadone at the time HAART was used (the IDU-methadone group; 75 patients), patients with a history of IDU who were not receiving methadone at the time that HAART was used (the IDU-nonmethadone group; 244 patients), and patients with no history of IDU (the non-IDU group; 490 patients). Results. At 12 months, 56% of DAART participants achieved an HIV type 1 RNA level <400 copies/mL, compared with 32% of participants in the IDU-methadone group (P = .009), 33% of those in the IDU-nonmethadone group (P = .001), and 44% of those in the non-IDU group (P = .077). The DAART group experienced a median increase in the CD4 cell count of 74 cells/mm3, compared with 21 cells/mm3 in the IDU-methadone group (P = .04), 33 cells/mm3 in the IDU-nonmethadone group (P = .09), and 84 cells/mm3 in the non-IDU group (P = .98). After adjustment for other covariates in a logistic regression model, DAART participants were significantly more likely to achieve viral suppression than were patients in each of the 3 comparison groups. Conclusions. These results suggest that methadone clinic—based DAART has the potential to provide substantial clinical benefit for HIV-infected IDUs.</description><subject>Adult</subject><subject>AIDS</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Antiretrovirals</subject><subject>Antiviral agents</subject><subject>Antivirals</subject><subject>Biological and medical sciences</subject><subject>CD4 Lymphocyte Count</subject><subject>Directly Observed Therapy</subject><subject>Female</subject><subject>Health outcomes</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV 1</subject><subject>HIV Infections - drug therapy</subject><subject>HIV/AIDS</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infectious diseases</subject><subject>Injections</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Methadone</subject><subject>Methadone - therapeutic use</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>RNA</subject><subject>RNA, Viral - blood</subject><subject>Substance abuse treatment</subject><subject>Substance Abuse, Intravenous - rehabilitation</subject><subject>Time Factors</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Viral Load</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kd9u0zAUxiMEYmPAEyBkkOCKgP_EsXNZddBWDCahglBvLMdxqLvEDrYz6FPxirik2664sn3O7_uOjr8se4rgWwR5-Y5CUkF6LztFlLC8pBW6n-6Q8rzghJ9kj0LYQYgQh_RhdoLKkmKC0Wn259x4rWK3B7OmN9aEqL1uwMzGVI_eXRsvO7Deai-HPTAWfNJxKxtnNZh3iVcBrAKYheCUkTEpf5m4Bat-SNL0Wq6-gbXXMvbaRnA5RuV6Hd6AuesH6W_wmzqQvbM_UtOq0fuDYuJMcBYsvBuH8Dh70Mou6CfH8yz7-uH9er7MLy4Xq_nsIlcFRTHHdaHbpoQMM0nrqpa0UhK3mjSMQYqxwrCQpK4rhXGLEFWlhIhKpCnSqi5Lcpa9nHzTIj9HHaLYudHbNFJgVFUU8gIm6PUEKe9C8LoVgze99HuBoDjEIqZYEvj86DbWvW7usGMOCXh1BGRQsmu9tMqEO45VmPB_Ri8mLv3F_4c9m5hdiM7fUkXBCw4Po_Kpfcj6921b-itRMsKoWH7fCE4-btjiy2exIX8BCWC58w</recordid><startdate>20060601</startdate><enddate>20060601</enddate><creator>Lucas, Gregory M.</creator><creator>Mullen, B. Anna</creator><creator>Weidle, Paul J.</creator><creator>Hader, Shannon</creator><creator>McCaul, Mary E.</creator><creator>Moore, Richard D.</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope></search><sort><creationdate>20060601</creationdate><title>Directly Administered Antiretroviral Therapy in Methadone Clinics Is Associated with Improved HIV Treatment Outcomes, Compared with Outcomes among Concurrent Comparison Groups</title><author>Lucas, Gregory M. ; Mullen, B. 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Antiparasitic agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Antiretrovirals</topic><topic>Antiviral agents</topic><topic>Antivirals</topic><topic>Biological and medical sciences</topic><topic>CD4 Lymphocyte Count</topic><topic>Directly Observed Therapy</topic><topic>Female</topic><topic>Health outcomes</topic><topic>Highly active antiretroviral therapy</topic><topic>HIV</topic><topic>HIV 1</topic><topic>HIV Infections - drug therapy</topic><topic>HIV/AIDS</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunodeficiencies</topic><topic>Immunodeficiencies. Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infectious diseases</topic><topic>Injections</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Methadone</topic><topic>Methadone - therapeutic use</topic><topic>Middle Aged</topic><topic>Pharmacology. 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Anna</creatorcontrib><creatorcontrib>Weidle, Paul J.</creatorcontrib><creatorcontrib>Hader, Shannon</creatorcontrib><creatorcontrib>McCaul, Mary E.</creatorcontrib><creatorcontrib>Moore, Richard D.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lucas, Gregory M.</au><au>Mullen, B. Anna</au><au>Weidle, Paul J.</au><au>Hader, Shannon</au><au>McCaul, Mary E.</au><au>Moore, Richard D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Directly Administered Antiretroviral Therapy in Methadone Clinics Is Associated with Improved HIV Treatment Outcomes, Compared with Outcomes among Concurrent Comparison Groups</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2006-06-01</date><risdate>2006</risdate><volume>42</volume><issue>11</issue><spage>1628</spage><epage>1635</epage><pages>1628-1635</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. Directly administered antiretroviral therapy (DAART) in methadone clinics has the potential to improve treatment outcomes for human immunodeficiency virus (HIV)—infected injection drug users (IDUs). Methods. DAART was provided at 3 urban methadone clinics. Eighty-two participants who were initiating or reinitiating highly active antiretroviral therapy (HAART) received supervised doses of therapy at the clinic on the mornings on which they received methadone. Treatment outcomes in the DAART group were compared with outcomes in 3 groups of concurrent comparison patients, who were drawn from the Johns Hopkins HIV Cohort. The concurrent comparison patients were taking HAART on a self-administered basis. The 3 groups of concurrent comparison patients were as follows: patients with a history of IDU who were receiving methadone at the time HAART was used (the IDU-methadone group; 75 patients), patients with a history of IDU who were not receiving methadone at the time that HAART was used (the IDU-nonmethadone group; 244 patients), and patients with no history of IDU (the non-IDU group; 490 patients). Results. At 12 months, 56% of DAART participants achieved an HIV type 1 RNA level <400 copies/mL, compared with 32% of participants in the IDU-methadone group (P = .009), 33% of those in the IDU-nonmethadone group (P = .001), and 44% of those in the non-IDU group (P = .077). The DAART group experienced a median increase in the CD4 cell count of 74 cells/mm3, compared with 21 cells/mm3 in the IDU-methadone group (P = .04), 33 cells/mm3 in the IDU-nonmethadone group (P = .09), and 84 cells/mm3 in the non-IDU group (P = .98). After adjustment for other covariates in a logistic regression model, DAART participants were significantly more likely to achieve viral suppression than were patients in each of the 3 comparison groups. Conclusions. These results suggest that methadone clinic—based DAART has the potential to provide substantial clinical benefit for HIV-infected IDUs.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>16652321</pmid><doi>10.1086/503905</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult AIDS Anti-HIV Agents - administration & dosage Anti-HIV Agents - therapeutic use Antibiotics. Antiinfectious agents. Antiparasitic agents Antiretroviral drugs Antiretroviral Therapy, Highly Active Antiretrovirals Antiviral agents Antivirals Biological and medical sciences CD4 Lymphocyte Count Directly Observed Therapy Female Health outcomes Highly active antiretroviral therapy HIV HIV 1 HIV Infections - drug therapy HIV/AIDS Human immunodeficiency virus Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Injections Male Medical sciences Methadone Methadone - therapeutic use Middle Aged Pharmacology. Drug treatments RNA RNA, Viral - blood Substance abuse treatment Substance Abuse, Intravenous - rehabilitation Time Factors Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Viral Load |
| title | Directly Administered Antiretroviral Therapy in Methadone Clinics Is Associated with Improved HIV Treatment Outcomes, Compared with Outcomes among Concurrent Comparison Groups |
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