Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis.
Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis.
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DOI：
10.1136/bmj.e5945
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发表时间：
2012-10-03
期刊：
影响因子：
--
通讯作者：
Hickman M
中科院分区：
文献类型：
--
作者：
MacArthur GJ;Minozzi S;Martin N;Vickerman P;Deren S;Bruneau J;Degenhardt L;Hickman M
目的量化注射吸毒者中阿片类药物替代治疗对HIV传播的影响。设计对已发表和未发表的观察性研究进行系统回顾和荟萃分析。数据来源：从最早的一年到2011年，无语言限制地检索Medline、Embase、SouInfo和Cochrane图书馆。综述方法我们选择了直接评估阿片替代治疗对艾滋病毒发病率影响的研究，以及评估注射吸毒者艾滋病毒发病率的研究，这些研究可能收集了与阿片替代治疗有关的暴露数据，但没有报告。我们联系了这些研究的作者。数据由两位评价者提取，并用随机效应模型进行荟萃分析。结果12篇研究阿片类药物替代治疗对HIV传播影响的已发表研究符合纳入标准，未发表的数据来自另外3项研究。所有研究都包括检查美沙酮维持治疗的研究。其中9项研究的数据可以汇集在一起，包括23年 608人年的819起艾滋病毒感染事件。在注射吸毒者中，阿片替代治疗与艾滋病毒感染风险降低54%相关(比率比0.46，95%可信区间0.32至0.67；P<；0.001)。研究之间存在异质性(I2=60%，χ2=20.12，P=0.010)，这不能用地理区域、招募地点或激励措施来解释。没有强有力的证据表明，较长时间的阿片替代治疗与更大的益处有关。结论作为维持治疗提供的阿片类替代治疗与降低注射吸毒者感染HIV的风险有关。然而，这些发现可能反映了在接受阿片类药物替代治疗的注射吸毒者中改变行为和减少注射风险行为的相对较高的动机。
Objective To quantify the effect of opiate substitution treatment in relation to HIV transmission among people who inject drugs. Design Systematic review and meta-analysis of prospective published and unpublished observational studies. Data sources Search of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction. Review methods We selected studies that directly assessed the impact of opiate substitution treatment in relation to incidence of HIV and studies that assessed incidence of HIV in people who inject drugs and that might have collected data regarding exposure to opiate substitution treatment but not have reported it. Authors of these studies were contacted. Data were extracted by two reviewers and pooled in a meta-analysis with a random effects model. Results Twelve published studies that examined the impact of opiate substitution treatment on HIV transmission met criteria for inclusion, and unpublished data were obtained from three additional studies. All included studies examined methadone maintenance treatment. Data from nine of these studies could be pooled, including 819 incident HIV infections over 23 608 person years of follow-up. Opiate substitution treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs (rate ratio 0.46, 95% confidence interval 0.32 to 0.67; P<0.001). There was evidence of heterogeneity between studies (I2=60%, χ2=20.12, P=0.010), which could not be explained by geographical region, site of recruitment, or the provision of incentives. There was weak evidence for greater benefit associated with longer duration of exposure to opiate substitution treatment. Conclusion Opiate substitution treatment provided as maintenance therapy is associated with a reduction in the risk of HIV infection among people who inject drugs. These findings, however, could reflect comparatively high levels of motivation to change behaviour and reduce injecting risk behaviour among people who inject drugs who are receiving opiate substitution treatment.
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影响因子：
105.7
作者：
Judd, A;Hickman, M;Hall, AJ
通讯作者：
Hall, AJ
DOI：
10.1136/bmj.c5475
发表时间：
2010-10-26
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Cornish, Rosie;Macleod, John;Hickman, Matt
通讯作者：
Hickman, Matt
DOI：
10.1136/bmj.c3172
发表时间：
2010-07-01
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Kimber J;Copeland L;Hickman M;Macleod J;McKenzie J;De Angelis D;Robertson JR
通讯作者：
Robertson JR
影响因子：
12.7
作者：
Des Jarlais, DC;Marmor, M;Friedman, SR
通讯作者：
Friedman, SR
影响因子：
6
作者：
Gandhi, DH;Jaffe, JH;Currens, M
通讯作者：
Currens, M