AIDS and Behavior

, Volume 14, Issue 4, pp 731–747

Adherence to Antiretroviral Therapy Among HIV-Infected Drug Users: A Meta-Analysis


    • Social Science Department, Sergio Arouca School of Public Health (DCS/ENSP)Oswaldo Cruz Foundation
  • Monica M. F. Magnanini
    • Institute of Public Health StudiesFederal University of Rio de Janeiro (IESC/UFRJ)
  • Steffanie A. Strathdee
    • Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine at University of CaliforniaSan Diego (UCSD) School of Medicine
  • Francisco I. Bastos
    • Health Information Laboratory, Center for Scientific and Technological Information (LIS/ICICT)Oswaldo Cruz Foundation
Original Paper

DOI: 10.1007/s10461-008-9489-7

Cite this article as:
Malta, M., Magnanini, M.M.F., Strathdee, S.A. et al. AIDS Behav (2010) 14: 731. doi:10.1007/s10461-008-9489-7


We conducted a meta-analysis of studies assessing adherence to highly active antiretroviral therapy (HAART) and a qualitative systematic review of factors associated with better HAART outcomes among HIV+ drug users (DU). Thirty-eight studies were considered, which analyzed 14,960 patients (11,394 HIV+ DU, 76.2%). Overall adherence (pooled percent of DU classified as adherent in each study) was 0.60 (95% CI: 0.52–0.68), similar to levels identified by studies conducted with HIV+ patients who are not drug users. Time frame used to measure adherence was an independent predictor of inter-study heterogeneity. The systematic review identified better HAART outcomes among former DU, those with less severe psychiatric conditions, those receiving opioid substitution therapy and/or psychosocial support. Patients initiating HAART with lower viral load and higher CD4 counts, and those without co-infections also had better treatment outcomes. Our findings suggest that HIV+ DU tend to be inappropriately assumed to be less adherent and unlikely to achieve desirable treatment outcomes, when compared to their non-DU cohort.


HIVAIDSAdherenceDrug useMeta-analysis

Copyright information

© Springer Science+Business Media, LLC 2008