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Methadone maintenance treatment modalities in relation to incidence of HIV: results of the Amsterdam cohort study

Langendam, Miranda W.a; van Brussel, Giel H.A.b; Coutinho, Roel A.a,c; van Ameijden, Erik J.C.a

Epidemiology and Social: Original Papers

Study objective: To evaluate methadone maintenance treatment modalities, prescribed within the concept of harm reduction, in relation to incidence of HIV infection among drug users with a history of methadone treatment in Amsterdam, The Netherlands.

Design: Prospective observational cohort study among 582 HIV-negative drug users. To ensure valid and detailed assessment of methadone treatment, data from the Central Methadone Register in Amsterdam were linked to the Amsterdam cohort study among drug users.

Methods: Poisson regression analysis was used to identify independent and significant predictors of incidence of HIV.

Main results: During 1906 person years, 58 drug users seroconverted, the overall incidence of HIV being 3.0 per 100 person years with a declining trend for current injectors. An increase in frequency of methadone programme attendance [relative risk (RR), 2.4; 95% confidence interval (CI), 1.2-4.6, compared with no change] and increase in methadone dosage (RR, 0.8; 95% CI, 0.6-1.0, per category of change of 10 mg/day) were significantly associated with incidence of HIV in multivariate analysis. Methadone dosage and frequency of programme attendance in itself were not significant predictors. Other multivariate significant risk factors were homelessness, current injecting and in-patient hospital care.

Conclusions: Among drug users who receive methadone maintenance treatment in a harm-reduction setting, which includes ancillary services such as needle-exchange programmes and HIV testing and counselling, prescription of high methadone dosages is not sufficient to stop the spread of HIV. However, an individual increase of the methadone dosage and measures to achieve high treatment retention could contribute to the prevention of HIV among drug users.

From the aDivision of Public Health and Environment and bDivision of Mental Health / Drug Department, Municipal Health Service and the cDepartment of Human Retrovirology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Sponsorship: This research was supported by the Netherlands Foundation for Preventive Medicine (grants no. 28-2370 and 1004) as part of the Stimulation Program on AIDS research of the Dutch Program Committee for AIDS Research (PccAo).

Note: This study was performed as part of the Amsterdam Cohort Studies on AIDS, a collaboration between the Municipal Health Service, the Academic Medical Centre and the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam, The Netherlands.

Correspondence to M.W. Langendam, MSc, Division of Public Health and Environment, Municipal Health Service, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.Tel.: (31) 20 555 5231; fax: (31) 20 555 5533, e-mail: mlangendam@gggd.amsterdam.nl

Received: 1 February 1999; revised: 7 May 1999; accepted: 20 May 1999.

© 1999 Lippincott Williams & Wilkins, Inc.