Drug treatment as HIV prevention: expanding treatment options.
Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data have emerged suggesting the prevention potential of medication-assisted treatments other than methadone (buprenorphine/naloxone and naltrexone). Still, with a few notable exceptions, global drug treatment coverage for opiate injectors remains remarkably low and only a few treatment interventions for stimulant use have shown efficacy in reducing HIV risk. Importantly, more recent data provide support for the role of drug treatment programs in improving access and adherence to antiretroviral treatment and that injection drug users in substance abuse treatment are more likely to achieve sustained viral suppression. While important challenges remain in maximizing its impact, the scientific literature provides strong evidence of the efficacy of drug treatment as an HIV prevention strategy.
Metzger
David S
DS
HIV/AIDS Prevention Research Division, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA. dsm@mail.med.upenn.edu
Zhang
Yan
Y
D000437:Alcoholism; D002047:Buprenorphine / Q000627:therapeutic use; D002985:Clinical Protocols; D055030:Drug Users; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D006293:Health Promotion; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009271:Naltrexone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation
D002047:Buprenorphine; D009271:Naltrexone; D008691:Methadone
Int J STD AIDS. 2009 Jun;20(6):399-405
19451325
Lancet. 2008 Jun 28;371(9631):2192-200
18586174
J Subst Abuse Treat. 2008 Jun;34(4):391-7
17869049
Addiction. 2010 Jan;105(1):100-8
20078464
Harm Reduct J. 2010 Mar 05;7:4
20205729
Addiction. 2008 Nov;103(11):1828-36
18778390
Lancet. 2010 Mar 20;375(9719):1014-28
20189638
Int J Addict. 1995 May;30(6):685-98
7657397
Drug Alcohol Depend. 2000 Apr 1;59(1):17-31
10706972
J Infect Dis. 2008 Jul 1;198(1):59-67
18498241
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007192
20091623
J Subst Abuse Treat. 2009 Sep;37(2):138-50
19150206
AIDS. 2006 Mar 21;20(5):731-9
16514304
J Acquir Immune Defic Syndr (1988). 1993 Sep;6(9):1049-56
8340896
Am J Epidemiol. 2006 Mar 1;163(5):412-20
16394200
Drug Alcohol Depend. 2003 Sep 10;71(3):295-302
12957347
J Acquir Immune Defic Syndr. 2001 May 1;27(1):86-90
11404525
AIDS Care. 2009 May;21(5):655-63
19444675
JAMA. 1993 Apr 21;269(15):1953-9
8385230
J Acquir Immune Defic Syndr. 2008 Aug 15;48(5):581-9
18645513
N Engl J Med. 2006 Jul 27;355(4):365-74
16870915
Clin Infect Dis. 2005 Sep 15;41(6):891-6
16107991
Clin Infect Dis. 2009 Nov 1;49(9):1433-40
19807275
Clin Infect Dis. 2010 May 15;50 Suppl 3:S149-55
20397942
J Acquir Immune Defic Syndr. 2010 Sep;55(1):65-72
20393347
Drug Alcohol Depend. 2003 May 21;70(2 Suppl):S79-85
12738352
Public Health Rep. 1998 Jun;113 Suppl 1:97-106
9722815
J Subst Abuse Treat. 2003 Apr;24(3):233-9
12810144
J Urban Health. 2000 Sep;77(3):331-45
10976608
Lancet. 2004 Jul 3-9;364(9428):41-50
15234855
J Health Soc Behav. 1988 Sep;29(3):214-26
3241064
J Subst Abuse Treat. 2006 Dec;31(4):319-28
17084785
Sex Transm Dis. 2005 Jan;32(1):27-34
15614118
AIDS Behav. 2005 Dec;9(4):423-32
16249946
Int J Drug Policy. 2010 Jan;21(1):4-9
19747811
Clin Infect Dis. 2006 Dec 15;43 Suppl 4:S247-53
17109311
J Subst Abuse Treat. 2008 Jul;35(1):87-92
17933486
Am J Psychiatry. 1999 Jan;156(1):27-33
9892294
J Subst Abuse Treat. 2004 Mar;26(2):67-78
15050083
Int J Drug Policy. 2007 Aug;18(4):262-70
17689374
Addiction. 2005 Feb;100(2):150-8
15679744
J Gen Intern Med. 2006 Feb;21(2):193-5
16336624
Clin Infect Dis. 2006 Jun 1;42(11):1628-35
16652321
Addiction. 2010 May;105(5):907-13
20331553
J Urban Health. 2007 Sep;84(5):653-66
17657607
Drug Alcohol Depend. 2009 Feb 1;100(1-2):115-21
19054631