Methadone maintenance and HIV infection

ENGLISH :
Methadone therapy has been widely shown to be the most effective treatment for opioid addiction. The increase in its use was promptly followed by a dwindling rate in the spread of HIV among heroin addicts. Clear benefits emerged, non only among directly treated patients, but also among non-addicts sharing the same environment. The positive impact of methadone upon addictive behaviours can be read mainly as a reduction in the likelihood of seroconversion. Retention in treatment is the most reliable predictor of a lower probability of seroconversion that will be maintained through time. The administration of methadone, even in cases for which stabilization has not been achieved, or for subjects who do not comply with methadone maintenance programmes, is still effective in a harm reduction perspective, in so far as it keeps infective risk lower than expected. In dually diagnosed patients, methadone, thanks to its psychopharmacological properties, has an immediately beneficial effect both on addiction-related behavioural disorders, and on further dysphoria and impulsiveness related to the adjunctive mental illness. Increasing numbers of heroin addicts should initiate methadone treatment, in order to minimize the likelihood of HIV - infection during the course of addictive practices. Moreover, stabilization, rather than a drug-free condition, should be regarded as the optimum therapeutic achievement. The advantage of this view appears evident when it is considered that, besides preventing relapses into heroin use, which could be checked by the re-initiation of a programme, stabilization forestalls frequent consequences of heroin use, such as HIV and HCV infection; these two conditions do not, at the moment, respond to any widely effective therapy. (Author' s abstract)