Can Methadone Lower Viral Loads?

Opioid addiction is an ugly beast. Addicts will go to great lengths in search of the blissful release of dopamine. With access to prescription drugs like fentanyl (which is 100 times more potent than morphine), overdoses are becoming depressingly common. And getting off opioids is no cake walk.

Physically, opioid withdrawal symptoms are among the hardest to endure of all drug classes. There’s the vomiting and diarrhea, whole-body muscle pain, racing heart, tremors, anxiety — all together it can make someone feel like they are going to die. Fortunately,
drugs like methadone are tailor-made to bypass some of the worst parts of opioid withdrawal and allow addicts to break their chemical dependency.

But people living with HIV who take methadone to reduce heroin or morphine withdrawals (or for pain — as it is sometimes prescribed) may discover an unexpected bonus: lower viral loads.

A study presented at the 22nd International AIDS Conference in Amsterdam demonstrated that methadone maintenance treatment (MMT) is associated with less time spent with a high viral load. The results are based on data from the AIDS Care Cohort to Evaluate Exposure to Survival Services in Vancouver, Canada.

Recognizing “people who inject drugs continue to experience individual, social, and structural barriers in accessing and being retained in HIV treatment and care,” researchers wanted to determine if a methadone maintenance therapy program could reduce the time of heightened HIV transmission risk (aka high viral loads) among HIV-positive people who use drugs.

For the study, researchers observed 867 HIV-positive people, all of whom also used drugs. During follow-ups, 60 percent were engaged in methadone maintenance therapy at least once. Researchers found the time participants spent on MMT correlated with fewer days of high viral loads.

Clinical methadone is an opioid, but one that goes through rigorous regulations and is closely monitored. Some risks include slowing breathing, which can lead to death, especially in overdose situations. But methadone has long been the go-to drug to help addicts break their chemical dependency to opioids like heroin.

For those who are on methadone maintenance therapy, the drug can help also keep your viral load in check, which is a significant finding, as viral suppression is essential to both health and the prevention of transmission.

Researchers wrote, “These findings suggest that low-threshold MMT is an effective intervention in lowering the risk of onward viral transmission among this key population.”

People living with HIV strive for an undetectable viral load, which means the virus is so suppressed that it is virtually impossible to transmit to an HIV-negative partner. Alternatively, high viral loads lead to a weakened immune system and complications down the road.

“These findings demonstrate the important role of evidence-based addiction treatment in optimizing individual and community-level impacts of antiretroviral therapy among HIV-positive patients with comorbid opioid dependence,” researchers added. “Efforts to address barriers to the use and availability of MMT will likely improve HIV outcomes and reduce new infections among this population and should therefore be prioritized.”

Future research may examine the mechanism in methadone that helps to reduce viral loads — and determine if it can be employed in HIV-focused medication.