Journal Article

Directly Observed Therapy for the Management of HIV-Infected Patients in a Methadone Program

Brian Conway, Jennie Prasad, Robert Reynolds, John Farley, Michelle Jones, Salima Jutha, Nadine Smith, Annabel Mead and Stanley DeVlaming

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 38, issue Supplement_5, pages S402-S408
Published in print June 2004 | ISSN: 1058-4838
Published online June 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/421404
Directly Observed Therapy for the Management of HIV-Infected Patients in a Methadone Program

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The objective of this prospective, observational clinical study was to evaluate the safety and efficacy of once-daily and twice-daily directly observed therapy (DOT) in human immunodeficiency virus (HIV)—infected patients undergoing methadone treatment. Methadone and highly active antiretroviral therapy (HAART) were dispensed daily as DOT, with patients in the twice-daily HAART group self-administering the second dose. Clinical and laboratory end points were monitored, along with the impact of ongoing cocaine use. We studied 54 patients coinfected with HIV and hepatitis C virus. At baseline, the median virus load was 111,000 copies/mL, and the median CD4+ cell count was 165 cells/mm3. After a median of 24 months, 17 of 29 patients in the once-daily HAART group and 18 of 25 in the twice-daily HAART group had virus loads of <400 copies/mL, regardless of ongoing cocaine use. Thirty-two patients required methadone dose adjustment, which was managed without modification of HAART. Treatment-limiting hepatic toxicity was rare. A DOT program of coadministered methadone and HAART can be implemented with good results, even for patients who continue to use cocaine.

Journal Article.  4254 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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