Observational analysis of German injecting drug users (IDU): survival with and without methadone maintenance treatment. German AIDS Study Group GASG/IdkF.
BACKGROUND
There are conflicting data on the effects of morphines on immunological functions in injecting drug users (IDU). In order to address whether methadone maintenance therapy for IDU with HIV infection results in any clinically important effects we did an observational study prompted by the fact that prospective trials are difficult to perform in IDU.


METHODS
Data on 1554 HIV-infected IDU were collected at 20 HIV/AIDS treatment centers using a standardized questionnaire. Items included demographic data, CD4 counts, HIV specific conditions and treatment. Patients who "ever received methadone" were compared to those who "never received methadone".


RESULTS
The mean observation time was 3.4 +/- 1.9 years. Using a stepwise Cox regression model, a low CD4 count, no antiretroviral therapy, no methadone therapy (p=0.0002), higher age and male sex were identified as independent predictors of shortened survival. Kaplan-Meier estimates indicated that patients with methadone had better survival (p=0.0002) after 200 CD4 cells and in matched pairs with a mean CD4 count of 520 +/- 315/microl at baseline CD4 slopes did no differ significantly.


CONCLUSIONS
This is a retrospective observational analysis which implicates several limitations in interpretation. There was no evidence of negative immunological outcome. Survival analysis suggests better survival in HIV-infected IDU who received methadone maintenance treatment.
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000401:mortality* / Q000534:rehabilitation*; D016019:Survival Analysis
D000701:Analgesics, Opioid; D008691:Methadone