Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis

• Published in: BMJ (Online) 2012-10, Vol.345 (7879), p.16-16
• Main Authors: MacArthur, Georgie J, Minozzi, Silvia, Martin, Natasha, Vickerman, Peter, Deren, Sherry, Bruneau, Julie, Degenhardt, Louisa, Hickman, Matthew
• Format: Article
• Language: English
• Subjects: Addictions; Alcohol; Confounding Factors, Epidemiologic; Disease transmission; Disease Transmission, Infectious - prevention & control; Disease Transmission, Infectious - statistics & numerical data; Drug development; Drug Misuse (Including Addiction); Drug use; Drugs Misuse (Including Addiction); Drugs: Musculoskeletal and Joint Diseases; Economic research; Epidemics; Evidence-based medicine; HIV; HIV infections; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; Human immunodeficiency virus; Humans; Immunology (Including Allergy); Infections; Infectious Diseases; Internet; Medical research; Meta-analysis; Methadone; Methadone - administration & dosage; Motivation; Narcotics; Narcotics - administration & dosage; Opiate Substitution Treatment - methods; Opiates; Primary Prevention - methods; Prospective Studies; Research Design; Research universities; Reviews; Risk Factors; Sexual Health; Substance abuse treatment; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - drug therapy; Systematic review; Time Factors
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.e5945

Objective To quantify the effect of opiate substitution treatment in relation to HIV transmission among people who inject drugs.Design Systematic review and meta-analysis of prospective published and unpublished observational studies.Data sources Search of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction.Review methods We selected studies that directly assessed the impact of opiate substitution treatment in relation to incidence of HIV and studies that assessed incidence of HIV in people who inject drugs and that might have collected data regarding exposure to opiate substitution treatment but not have reported it. Authors of these studies were contacted. Data were extracted by two reviewers and pooled in a meta-analysis with a random effects model.Results Twelve published studies that examined the impact of opiate substitution treatment on HIV transmission met criteria for inclusion, and unpublished data were obtained from three additional studies. All included studies examined methadone maintenance treatment. Data from nine of these studies could be pooled, including 819 incident HIV infections over 23 608 person years of follow-up. Opiate substitution treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs (rate ratio 0.46, 95% confidence interval 0.32 to 0.67; P