Methadone treatment of injecting opioid users for prevention of HIV infection

Abstract

OBJECTIVE: To assess the effects of oral substitution treatment for opioid-dependent injecting drug users on HIV risk behaviors and infections. DATA SOURCES: Multiple electronic databases were searched. Reference lists of retrieved articles were checked. METHODS: Because of varying methodologies of available studies, this systematic review was limited to a descriptive summary, looking at consistency of outcomes across studies. RESULTS: Twenty-eight studies involving methadone treatment were included in the review. Methadone maintenance treatment is associated with statistically significant reductions in injecting use and sharing of injecting equipment. It is also associated with reductions in numbers of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviors do translate into fewer cases of HIV infection. CONCLUSIONS: Methadone maintenance treatment for injecting drug users significantly reduces the risk of transmission of HIV and should be provided as a component of a strategic approach to the prevention and control of HIV infection. There is insufficient evidence to determine whether other forms of oral substitution treatment also reduce the risk of HIV transmission.