title: Directly observed therapy for the management of HIV-infected patients in a methadone program.
abstract: 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.
authors.affiliation: Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, V6Z2C7, Canada. bconway@interchange.ubc.ca
authors.forename: Brian
authors.initials: B
authors.lastname: Conway
authors.forename: Jennie
authors.initials: J
authors.lastname: Prasad
authors.forename: Robert
authors.initials: R
authors.lastname: Reynolds
authors.forename: John
authors.initials: J
authors.lastname: Farley
authors.forename: Michelle
authors.initials: M
authors.lastname: Jones
authors.forename: Salima
authors.initials: S
authors.lastname: Jutha
authors.forename: Nadine
authors.initials: N
authors.lastname: Smith
authors.forename: Annabel
authors.initials: A
authors.lastname: Mead
authors.forename: Stanley
authors.initials: S
authors.lastname: DeVlaming
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D008691:Methadone