ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2015
The Effects of Opioid Substitution Treatment and Highly Active Antiretroviral Therapy on the Cause-Specific Risk of Mortality Among HIV-Positive People Who Inject Drugs.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 5 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Pooled it
- Pooled it
- Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis.Molecular psychiatry · 2019Pooled it
- Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.BMJ (Clinical research ed.) · 2017Pooled it
- Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Pooled it
- Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia.Contemporary clinical trials · 2017Trial
- Modeling the impact of changing drug markets and structural determinants on HCV and/or HIV transmission among people who inject drugs in the United States: A rural and urban comparison.The International journal on drug policy · 2025Article
- "We want everything in a one-stop shop": acceptability and feasibility of PrEP and buprenorphine implementation with mobile syringe services for Black people who inject drugs.Harm reduction journal · 2022Article
- Nurse Practitioner-Led Integrated Rapid Access to HIV Prevention for People Who Inject Drugs (iRaPID): Protocol for a Pilot Randomized Controlled Trial.JMIR research protocols · 2022Article
- Recruitment into a Clinical Trial of People Living with Uncontrolled HIV Infection Who Inject Drugs: a Site Case Report from the CTN 67 CHOICES Study.The journal of behavioral health services & research · 2022Article
- Assessing the determinants of completing OAT induction and long-term retention: A population-based study in British Columbia, Canada.Journal of substance abuse treatment · 2022Article
- The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study.The Lancet. Public health · 2022Article
- A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam.Journal of clinical epidemiology · 2021Article
- Effect of HIV, antiretrovirals, and genetics on methadone pharmacokinetics: Results from the methadone antiretroviral pharmacokinetics study.Drug and alcohol dependence · 2021Article
- Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug-related poisoning deaths? A retrospective cohort study.Addiction (Abingdon, England) · 2020Observational
- Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities.The Journal of infectious diseases · 2020Article
- Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England.Wellcome open research · 2020Article
- Cost-effectiveness of integrating buprenorphine-naloxone treatment for opioid use disorder into clinical care for persons with HIV/hepatitis C co-infection who inject opioids.The International journal on drug policy · 2019Article
- Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA: a modelling study.The lancet. HIV · 2019Article
- Opioid agonist treatment dosage and patient-perceived dosage adequacy, and risk of hepatitis C infection among people who inject drugs.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundPrior studies indicated opioid substitution treatment (OST) reduces mortality risk and improves the odds of accessing highly active antiretroviral therapy (HAART); however, the relative effects of these treatments for human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) are unclear. We determine the independent and joint effects of OST and HAART on mortality, by cause, within a population of HIV-positive PWID initiating HAART.
methodsUsing a linked population-level database for British Columbia, Canada, we used time-to-event analytic methods, including competing risks models, proportional hazards models with time-varying covariates, and marginal structural models, to identify the independent and joint effects of OST and HAART on all-cause as well as drug- and HIV-related mortality, controlling for covariates.
resultsAmong 1727 HIV-positive PWID, 493 (28.5%) died during a median 5.1 years (interquartile range, 2.1-9.1) of follow-up: 18.7% due to drug-related causes, 55.8% due to HIV-related causes, and 25.6% due to other causes. Standardized mortality ratios were 12.2 (95% confidence interval [CI], 9.8, 15.0) during OST and 30.0 (27.1, 33.1) during periods out of OST. Both OST (adjusted hazard, 0.34; 95% CI, .23, .49) and HAART (0.39 [0.31, 0.48]) decreased the hazard of all-cause mortality; however, individuals were at lowest risk of death when these medications were used jointly (0.16 [0.10, 0.26]). Both OST and HAART independently protected against HIV-related death, drug-related death and death due to other causes.
conclusionsWhile both OST and HAART are life-saving treatments, joint administration is urgently needed to protect against both drug- and HIV-related mortality.
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