Modified directly observed therapy (MDOT) for injection drug users with HIV disease

Elinore F. McCance-Katz, Marc N. Gourevitch, Julia H. Arnsten, Julie Sarlo, Petrie Rainey, Peter Jatlow

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Injection drug use is an important factor in the spread of HIV infection, and strategies to enhance adherence to HIV therapeutics are critically important to controlling viral transmission and improving clinical outcomes. To this end, the authors sought (1) to enhance adherence to highly active antiretroviral therapy (HAART) among methadone-maintained injection drug users (IDUs) using modified directly observed therapy (MDOT), and (2) to define interactions between methadone and HAART and the potential contribution of drug interactions to adherence and HIV outcomes in this population. Adherence was explored here through a pilot, unblinded, 24-week study in a methadone maintenance program in which simplified HAART (efavirenz and didanosine [once daily] and a second nucleoside [twice daily]) was administered 6 days/week by clinic staff to HIV-infected IDUs (n = 5) with their methadone. Evening doses of riboflavin-tagged nucleoside and one full day of medication weekly were given as take home doses. As a result of HAART administration, four of five participants with mean viral load at baseline of 105 copies/ml had undetectable viral load by 8 weeks of treatment (p = .043). Methadone area under the curve (AUC) decreased by 55% (p = .007) within 2 weeks of initiating this HAART regimen, and a mean methadone dose increase of 52% was required. The authors conclude that MDOT is a promising intervention for the treatment of ID Us mith HIV disease, though significant drug interactions must be monitored for carefully and rapidly addressed.

Original languageEnglish (US)
Pages (from-to)271-278
Number of pages8
JournalAmerican Journal on Addictions
Volume11
Issue number4
DOIs
StatePublished - Sep 2002

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Directly Observed Therapy
Methadone
Drug Users
Highly Active Antiretroviral Therapy
HIV
Injections
efavirenz
Viral Load
Drug Interactions
Nucleosides
Didanosine
Riboflavin
Area Under Curve
HIV Infections
Therapeutics
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

Modified directly observed therapy (MDOT) for injection drug users with HIV disease. / McCance-Katz, Elinore F.; Gourevitch, Marc N.; Arnsten, Julia H.; Sarlo, Julie; Rainey, Petrie; Jatlow, Peter.

In: American Journal on Addictions, Vol. 11, No. 4, 09.2002, p. 271-278.

Research output: Contribution to journalArticle

McCance-Katz, Elinore F. ; Gourevitch, Marc N. ; Arnsten, Julia H. ; Sarlo, Julie ; Rainey, Petrie ; Jatlow, Peter. / Modified directly observed therapy (MDOT) for injection drug users with HIV disease. In: American Journal on Addictions. 2002 ; Vol. 11, No. 4. pp. 271-278.
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