Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan (K-HW, C-HC, H-YC); Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan (K-HW, C-HC); Da-An Psychiatry Clinic, Taipei, Taiwan (S-CJ); Sun-Yuan Chou Clinic, Taoyuan, Taiwan (S-YC); Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan (H-YC).
J Addict Med. 2020 Dec;14(6):e310-e315. doi: 10.1097/ADM.0000000000000658.
Opioids have been hypothesized to suppress the immune function and worsen outcomes among people living with human immunodeficiency virus (HIV). The study aimed to identify key factors associated with the increased cluster of differentiation 4 (CD4) cell counts among HIV-positive people who inject heroin and receive methadone maintenance treatment (MMT).
This longitudinal study was conducted at a psychiatric hospital in Northern Taiwan. Participants were recruited from 2006 through 2011, and received CD4 cell counts and HIV viral load monitoring once every 4 to 6 months. Trend in CD4 cell counts, defined as change in CD4 cell count over time, was used as the outcome measure. Independent variables included MMT-related factors and baseline characteristics. Baseline characteristics included age, gender, CD4 cell count, HIV viral load, tests for other infections, liver function tests, and urine drug screens.
Three hundred and fifty one participants were recruited during the study period. The multivariate linear mixed model analysis revealed a higher MMT attendance rate, a higher baseline CD4 cell count, and a shorter duration of MMT were associated with an increase in CD4 cell count over time.
The study showed better adherence to MMT was associated with better preserved immune functions. The negative impact of duration of MMT on CD4 cell counts may be ameliorated by improving the attendance rate, initiation of MMT earlier when the baseline CD4 cell count is still relatively high and by the other beneficial effects of MMT, such as healthier lifestyles with reduced use of short-acting opioids.
阿片类药物被认为会抑制免疫功能，并使人类免疫缺陷病毒（HIV）感染者的预后恶化。本研究旨在确定与接受美沙酮维持治疗（MMT）的海洛因注射吸毒的 HIV 阳性者中 CD4 细胞计数增加相关的关键因素。
这项纵向研究在台湾北部的一家精神病医院进行。参与者于 2006 年至 2011 年期间招募，并每 4 至 6 个月接受一次 CD4 细胞计数和 HIV 病毒载量监测。CD4 细胞计数趋势（定义为随时间推移的 CD4 细胞计数变化）被用作结局指标。独立变量包括 MMT 相关因素和基线特征。基线特征包括年龄、性别、CD4 细胞计数、HIV 病毒载量、其他感染检测、肝功能检查和尿液药物筛查。
在研究期间，共招募了 351 名参与者。多变量线性混合模型分析显示，较高的 MMT 出席率、较高的基线 CD4 细胞计数和较短的 MMT 持续时间与 CD4 细胞计数随时间的增加相关。
该研究表明，更好地遵守 MMT 与更好地维持免疫功能有关。MMT 持续时间对 CD4 细胞计数的负面影响可能通过提高出勤率、在基线 CD4 细胞计数仍相对较高时更早开始 MMT 以及通过 MMT 的其他有益效果（如减少使用短效阿片类药物的更健康的生活方式）来减轻。
