Directly observed therapy for the management of HIV-infected patients in a methadone program.
The objective of this prospective, observational clinical study was to evaluate the safety and efficacy of once-daily and twice-daily directly observed therapy (DOT) in human immunodeficiency virus (HIV)-infected patients undergoing methadone treatment. Methadone and highly active antiretroviral therapy (HAART) were dispensed daily as DOT, with patients in the twice-daily HAART group self-administering the second dose. Clinical and laboratory end points were monitored, along with the impact of ongoing cocaine use. We studied 54 patients coinfected with HIV and hepatitis C virus. At baseline, the median virus load was 111,000 copies/mL, and the median CD4+ cell count was 165 cells/mm3. After a median of 24 months, 17 of 29 patients in the once-daily HAART group and 18 of 25 in the twice-daily HAART group had virus loads of <400 copies/mL, regardless of ongoing cocaine use. Thirty-two patients required methadone dose adjustment, which was managed without modification of HAART. Treatment-limiting hepatic toxicity was rare. A DOT program of coadministered methadone and HAART can be implemented with good results, even for patients who continue to use cocaine.
Conway
Brian
B
Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, V6Z2C7, Canada. bconway@interchange.ubc.ca
Prasad
Jennie
J
Reynolds
Robert
R
Farley
John
J
Jones
Michelle
M
Jutha
Salima
S
Smith
Nadine
N
Mead
Annabel
A
DeVlaming
Stanley
S
D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D019970:Cocaine-Related Disorders / Q000150:complications; D023801:Directly Observed Therapy; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D008691:Methadone