title: Association of patterns of methadone use with antiretroviral therapy discontinuation: a prospective cohort study.
abstract: BACKGROUND
  Methadone maintenance therapy (MMT) is a proven treatment strategy for opioid dependent patients. Although studies have demonstrated that MMT increases contact with the medical system and improves adherence to antiretroviral therapy (ART) in HIV-positive people who inject drugs (PWID), the effect of MMT discontinuation on ART discontinuation has not been well described.
  
  
  METHODS
  We examined the impact of continuous MMT use, MMT non-use and MMT discontinuation on the time to ART discontinuation (defined as 90 days of continuous non-use following previous enrolment) in a community-recruited prospective cohort of HIV-positive PWID followed between May 1996 and May 2013 in Vancouver, Canada. Multivariate Cox proportional hazards regression was used to examine the association between MMT use patterns and time to ART discontinuation while adjusting for socio-demographic confounders.
  
  
  RESULTS
  A total of 794 HIV-positive PWID were included during the study period. In an adjusted analysis, in comparison to those who were continuously on MMT, MMT non-use (Adjusted Hazard Ratio [AHR] = 1.44, 95 % Confidence Interval [CI]: 1.19-1.73) as well as discontinuing MMT (AHR = 1.82, 95 % CI: 1.27-2.60) were both found to be independently associated with time to ART discontinuation.
  
  
  CONCLUSIONS
  This study reinforces the known benefits of MMT use on ART adherence and demonstrates how discontinuation of MMT is independently associated with an increased risk of ART cessation. These data highlight the importance of retaining PWID on MMT.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada. pbach@qmed.ca.
authors.forename: Paxton
authors.initials: P
authors.lastname: Bach
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. uhri-ew@cfenet.ubc.ca.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada. uhri-ew@cfenet.ubc.ca.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. hdong@cfenet.ubc.ca.
authors.forename: Huiru
authors.initials: H
authors.lastname: Dong
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. sguillemi@cfenet.ubc.ca.
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. uhri-tk@cfenet.ubc.ca.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada. uhri-tk@cfenet.ubc.ca.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. jmontaner@cfenet.ubc.ca.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada. jmontaner@cfenet.ubc.ca.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. uhri-mjsm@cfenet.ubc.ca.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada. uhri-mjsm@cfenet.ubc.ca.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data
chemical_list: D044966:Anti-Retroviral Agents; D008691:Methadone