A Cochrane review [Abstract] 1 included 28 studies on the effect of oral substitution treatment for opioid dependent injecting drug users on rates of HIV infections, with some 12 400 subjects. The majority were not randomised controlled studies and there were problems of confounding and bias. The studies varied in several aspects limiting the extent of quantitative analysis.
Oral substitution treatment for opioid-dependent injecting drug users is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviours related to drug use do translate into reductions in cases of HIV infection.
Comment: The quality of evidence is downgraded by limitations in study quality (mainly observational studies) and by inconsistency (heterogeneity in interventions and outcomes).
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