Document Detail


Directly observed antiretroviral therapy in substance abusers receiving methadone maintenance therapy does not cause increased drug resistance.
MedLine Citation:
PMID:  20854173     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Direct observation of antiretroviral therapy (DOT) can increase adherence rates in HIV-infected substance users, but whether this affects the development of antiretroviral drug resistance has not been fully explored. We conducted a 24-week randomized controlled trial of methadone clinic-based antiretroviral DOT compared with treatment as usual (TAU) among antiretroviral-experienced substance users. To examine the development of new resistance mutations, we identified all participants with an amplifiable resistance test at both baseline and either week 8 or week 24. We compared the development of new drug resistance mutations between participants in the two arms of the trial. Among the 77 participants enrolled in the parent trial, antiretroviral DOT was efficacious for improving adherence and decreasing HIV viral load. Twenty-one participants had a detectable HIV viral load at both baseline and a second time point. Of these, nine developed new drug resistance mutations not seen at baseline (three in the DOT arm and six in the TAU arm; p = 0.27). Overall, five subjects in the TAU arm developed major mutations correlating with their current antiretroviral regimen, while no subjects in the DOT arm developed such mutations. Direct observation of antiretroviral therapy was associated with improved adherence and viral suppression among methadone maintained HIV-infected substance users, but was not associated with an increase in the development of antiretroviral drug resistance. DOT should be considered for substance users attending methadone maintenance clinics who are at high risk of nonadherence.
Authors:
James C M Brust; Alain H Litwin; Karina M Berg; Xuan Li; Moonseong Heo; Julia H Arnsten
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2010-11-23
Journal Detail:
Title:  AIDS research and human retroviruses     Volume:  27     ISSN:  1931-8405     ISO Abbreviation:  AIDS Res. Hum. Retroviruses     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-05     Completed Date:  2011-08-09     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  8709376     Medline TA:  AIDS Res Hum Retroviruses     Country:  United States    
Other Details:
Languages:  eng     Pagination:  535-41     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Adult
Amino Acid Substitution
Analgesics, Opioid / administration & dosage
Anti-HIV Agents / administration & dosage*
Directly Observed Therapy / methods*
Drug Resistance, Viral*
Female
HIV / drug effects*,  genetics,  isolation & purification
HIV Infections / complications,  drug therapy*
Humans
Male
Medication Adherence / statistics & numerical data
Methadone / administration & dosage*
Middle Aged
Mutation, Missense
Substance-Related Disorders / complications,  drug therapy*
Treatment Outcome
Viral Load
Viral Proteins / genetics
Grant Support
ID/Acronym/Agency:
K23 AI083088/AI/NIAID NIH HHS; K23 DA021087/DA/NIDA NIH HHS; P30 AI051519/AI/NIAID NIH HHS; R01 DA015302/DA/NIDA NIH HHS; R25 DA14551/DA/NIDA NIH HHS
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anti-HIV Agents; 0/Viral Proteins; UC6VBE7V1Z/Methadone
Comments/Corrections

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