title: Drug treatment as HIV prevention: expanding treatment options.
abstract: 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.
authors.affiliation: HIV/AIDS Prevention Research Division, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA. dsm@mail.med.upenn.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Metzger
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
mesh_terms: 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
chemical_list: D002047:Buprenorphine; D009271:Naltrexone; D008691:Methadone
references.citation: Int J STD AIDS. 2009 Jun;20(6):399-405
references.pmid: 19451325
references.citation: Lancet. 2008 Jun 28;371(9631):2192-200
references.pmid: 18586174
references.citation: J Subst Abuse Treat. 2008 Jun;34(4):391-7
references.pmid: 17869049
references.citation: Addiction. 2010 Jan;105(1):100-8
references.pmid: 20078464
references.citation: Harm Reduct J. 2010 Mar 05;7:4
references.pmid: 20205729
references.citation: Addiction. 2008 Nov;103(11):1828-36
references.pmid: 18778390
references.citation: Lancet. 2010 Mar 20;375(9719):1014-28
references.pmid: 20189638
references.citation: Int J Addict. 1995 May;30(6):685-98
references.pmid: 7657397
references.citation: Drug Alcohol Depend. 2000 Apr 1;59(1):17-31
references.pmid: 10706972
references.citation: J Infect Dis. 2008 Jul 1;198(1):59-67
references.pmid: 18498241
references.citation: Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007192
references.pmid: 20091623
references.citation: J Subst Abuse Treat. 2009 Sep;37(2):138-50
references.pmid: 19150206
references.citation: AIDS. 2006 Mar 21;20(5):731-9
references.pmid: 16514304
references.citation: J Acquir Immune Defic Syndr (1988). 1993 Sep;6(9):1049-56
references.pmid: 8340896
references.citation: Am J Epidemiol. 2006 Mar 1;163(5):412-20
references.pmid: 16394200
references.citation: Drug Alcohol Depend. 2003 Sep 10;71(3):295-302
references.pmid: 12957347
references.citation: J Acquir Immune Defic Syndr. 2001 May 1;27(1):86-90
references.pmid: 11404525
references.citation: AIDS Care. 2009 May;21(5):655-63
references.pmid: 19444675
references.citation: JAMA. 1993 Apr 21;269(15):1953-9
references.pmid: 8385230
references.citation: J Acquir Immune Defic Syndr. 2008 Aug 15;48(5):581-9
references.pmid: 18645513
references.citation: N Engl J Med. 2006 Jul 27;355(4):365-74
references.pmid: 16870915
references.citation: Clin Infect Dis. 2005 Sep 15;41(6):891-6
references.pmid: 16107991
references.citation: Clin Infect Dis. 2009 Nov 1;49(9):1433-40
references.pmid: 19807275
references.citation: Clin Infect Dis. 2010 May 15;50 Suppl 3:S149-55
references.pmid: 20397942
references.citation: J Acquir Immune Defic Syndr. 2010 Sep;55(1):65-72
references.pmid: 20393347
references.citation: Drug Alcohol Depend. 2003 May 21;70(2 Suppl):S79-85
references.pmid: 12738352
references.citation: Public Health Rep. 1998 Jun;113 Suppl 1:97-106
references.pmid: 9722815
references.citation: J Subst Abuse Treat. 2003 Apr;24(3):233-9
references.pmid: 12810144
references.citation: J Urban Health. 2000 Sep;77(3):331-45
references.pmid: 10976608
references.citation: Lancet. 2004 Jul 3-9;364(9428):41-50
references.pmid: 15234855
references.citation: J Health Soc Behav. 1988 Sep;29(3):214-26
references.pmid: 3241064
references.citation: J Subst Abuse Treat. 2006 Dec;31(4):319-28
references.pmid: 17084785
references.citation: Sex Transm Dis. 2005 Jan;32(1):27-34
references.pmid: 15614118
references.citation: AIDS Behav. 2005 Dec;9(4):423-32
references.pmid: 16249946
references.citation: Int J Drug Policy. 2010 Jan;21(1):4-9
references.pmid: 19747811
references.citation: Clin Infect Dis. 2006 Dec 15;43 Suppl 4:S247-53
references.pmid: 17109311
references.citation: J Subst Abuse Treat. 2008 Jul;35(1):87-92
references.pmid: 17933486
references.citation: Am J Psychiatry. 1999 Jan;156(1):27-33
references.pmid: 9892294
references.citation: J Subst Abuse Treat. 2004 Mar;26(2):67-78
references.pmid: 15050083
references.citation: Int J Drug Policy. 2007 Aug;18(4):262-70
references.pmid: 17689374
references.citation: Addiction. 2005 Feb;100(2):150-8
references.pmid: 15679744
references.citation: J Gen Intern Med. 2006 Feb;21(2):193-5
references.pmid: 16336624
references.citation: Clin Infect Dis. 2006 Jun 1;42(11):1628-35
references.pmid: 16652321
references.citation: Addiction. 2010 May;105(5):907-13
references.pmid: 20331553
references.citation: J Urban Health. 2007 Sep;84(5):653-66
references.pmid: 17657607
references.citation: Drug Alcohol Depend. 2009 Feb 1;100(1-2):115-21
references.pmid: 19054631