Socías M Eugenia, Wood Evan, Small Will, Dong Huiru, Shoveller Jean, Kerr Thomas, Montaner Julio, Milloy M-J
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Drug Alcohol Depend. 2016 Nov 1;168:211-218. doi: 10.1016/j.drugalcdep.2016.09.013. Epub 2016 Sep 20.
Methadone maintenance therapy (MMT) is associated with improved HIV treatment outcomes among people who use drugs (PWUD). The extent to which these benefits are sustained in the context of ongoing cocaine use is unclear. We assessed differential impacts of MMT on HIV viral load (VL) suppression in relation to discrete patterns of cocaine use.
Data was drawn from ACCESS, a prospective cohort of HIV-positive PWUD in Vancouver, Canada. Generalized linear mixed-effects were used to model the independent effect of MMT on VL suppression across strata of frequency of cocaine injection and crack smoking (≥daily versus <daily), after adjustment for confounders.
The analysis included 397 HIV-positive opioid users who completed ≥1 study interview between 2005 and 2014. At baseline, 304 (77%) reported participation in MMT, 37 (9%) ≥daily cocaine injection, and 158 (40%) ≥daily crack smoking. In adjusted analyses, MMT remained independently associated with increased odds of VL suppression in both strata of crack smokers (AOR=3.11, 95% CI: 1.86-5.21 and AOR=1.48, 95%CI: 1.04-2.09, for ≥daily and <daily smokers, respectively), and among <daily cocaine injectors (AOR=1.88, 95%CI 1.38-2.56), but not among ≥daily cocaine injectors (AOR=1.37, 95%CI 0.53-3.49). Longer retention on MMT was positively associated with VL suppression in all strata of cocaine injection and crack smoke.
Exposure to MMT was associated with increased odds of VL suppression among HIV- positive opioid users regardless of crack use. However, this beneficial effect of MMT was lost among frequent cocaine injectors with shorter retention on MMT.
美沙酮维持治疗（MMT）与改善吸毒者（PWUD）的艾滋病毒治疗结果相关。在持续使用可卡因的情况下，这些益处能持续到何种程度尚不清楚。我们评估了MMT对艾滋病毒病毒载量（VL）抑制的不同影响与可卡因使用的离散模式之间的关系。
数据来自ACCESS，这是加拿大温哥华一个艾滋病毒阳性吸毒者的前瞻性队列。在调整混杂因素后，使用广义线性混合效应模型来模拟MMT对不同可卡因注射频率和快克可卡因吸食频率（≥每日与<每日）分层的VL抑制的独立影响。
分析纳入了397名在2005年至2014年间完成≥1次研究访谈的艾滋病毒阳性阿片类药物使用者。基线时，304人（77%）报告参与了MMT，37人（9%）≥每日注射可卡因，158人（40%）≥每日吸食快克可卡因。在调整分析中，MMT在快克可卡因吸食者的两个分层中（分别为≥每日和<每日吸食者，调整后比值比[AOR]=3.11，95%置信区间[CI]：1.86 - 5.21和AOR=1.48，95%CI：1.04 - 2.09）以及<每日注射可卡因者中（AOR=1.88，95%CI 1.38 - 2.56）仍与VL抑制几率增加独立相关，但在≥每日注射可卡因者中并非如此（AOR=1.37，95%CI 0.53 - 3.49）。在所有可卡因注射和快克可卡因吸食分层中，MMT的更长保留时间与VL抑制呈正相关。
无论是否使用快克可卡因，接触MMT都与艾滋病毒阳性阿片类药物使用者中VL抑制几率增加相关。然而，MMT的这种有益效果在MMT保留时间较短的频繁可卡因注射者中消失了。
