Directly administered antiretroviral therapy in methadone clinics is associated with improved HIV treatment outcomes, compared with outcomes among concurrent comparison groups
Directly administered antiretroviral therapy in methadone clinics is associated with improved HIV treatment outcomes, compared with outcomes among concurrent comparison groups
复制标题
DOI：
10.1086/503905
复制
发表时间：
2006-06-01
影响因子：
11.8
通讯作者：
Moore, RD
中科院分区：
文献类型：
--
作者：
Lucas, GM;Mullen, BA;Moore, RD
背景资料。美沙酮诊所的直接给药抗逆转录病毒疗法(DAART)有可能改善人类免疫缺陷病毒(HIV)感染的静脉吸毒者(IDUs)的治疗结果。在3个城市美沙酮诊所提供了DAART。82名开始或重新开始高效抗逆转录病毒疗法(HAART)的参与者在接受美沙酮治疗的当天上午在诊所接受了监督剂量的治疗。DAART组的治疗结果与来自约翰霍普金斯大学HIV队列的3组同期对照患者的结果进行了比较。同时比较的患者是在自我给药的基础上服用HAART。同时比较的3组患者分别是：在使用HAART时有IDU病史并接受美沙酮治疗的患者(IDU-美沙酮组，75例)，在HAART使用时未接受美沙酮治疗的IDU病史患者(IDU-非美沙酮组，244例)，以及无IDU病史的患者(非IDU组，490例)。在12个月时，56%的DAART参与者的HIV 1型RNA水平达到400拷贝/毫升，相比之下，IDU-美沙酮组的参与者为32%(P=.009)，非IDU组的参与者为33%(P=.001)，非IDU组的参与者为44%(P=.077)。DAART组的CD4细胞计数中位数为74个/mm(3)，而IDU-美沙酮组为21个/mm(3)(P=0.04)，非IDU组为33个/mm(3)(P=0.09)，非IDU组为84个/mm(3)(P=.98)。在对Logistic回归模型中的其他协变量进行调整后，DAART参与者实现病毒抑制的可能性显著高于3个对照组中的患者。这些结果表明，以美沙酮诊所为基础的DAART有可能为艾滋病毒感染的注射吸毒者提供实质性的临床益处。
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/mm(3), compared with 21 cells/mm(3) in the IDU-methadone group (P = .04), 33 cells/mm(3) in the IDU-nonmethadone group (P = .09), and 84 cells/mm(3) 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.