DID ALCOHOL REDUCE HEROIN USE? A HIGHLIGHT FROM HIV/HCV CO- INFECTED METHADONE MAINTENANCE PATIENTS IN MYANMAR

Abstract

Intro: The HIV/HCV co-infection prevalence among people who inject drugs (PWIDs) in Myanmar was high (26.8%). This research identified alcohol consumption effect on heroin use among HIV/HCV co-infected PWIDs treated on methadone. This diversion effect can subsequently reduce injection-related transmission from co-infected patients. Methods: This cross-sectional study was conducted in 5 cities across Myanmar, where 210 patients who reported a minimum of six months on methadone treatment were recruited through stratified random sampling. The respondents' alcohol, drug use, and HIV and hepatitis infection history were collected with a semi-structured questionnaire. All respondents were screened for their drug use status with urinalysis for methadone, heroin, cannabis, amphetamine, methamphetamine, and benzodiazepine. Findings: Thirty-four (16%) reported HIV and HCV co-infection among 210 PWIDs treated on methadone. Almost one-third,(n=66) used alcohol, and a majority (80%,n=167) were categorized as ''no or less alcohol use''. Seventy-four percent (n=155) tested positive for using an illicit drug during treatment. Higher alcohol usage was significantly associated with higher Addiction Severity Index on Alcohol, lower income group, respondents who enjoyed their leisure time with friends, and those who had negative urine results on heroin, and poly-drugs (p<0.05). Patients with a co-infection status who reported high alcohol use were more likely to have a negative urine result for illicit drugs (p<0.0342) than co- infected patients with low alcohol use. Similarly, co-infected patients with high alcohol use were less likely to use heroin (p<0.030) and poly-drugs (p<0.041) compared to co-infected patients with low alcohol use. Regardless of co-infection status, there was a significant reduction in illicit drug use with the interaction of alcohol and current methadone dose (p<0.0032). Conclusion: Alcohol consumption during methadone treatment affects heroin and poly-drug use of HIV/HCV co-infected patients. Further comprehensive analysis of this inverse relationship will be beneficial by considering socio- economic, behavioural and pharmacological interactions among co-infected patients with further HIV/HCV treatments.