Journal of General Internal Medicine

, Volume 16, Issue 9, pp 625–633

Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons

  • Barbara J. Turner
  • John A. Fleishman
  • Neil Wenger
  • Andrew S. London
  • M. Audrey Burnam
  • Martin F. Shapiro
  • Eric G. Bing
  • Michael D. Stein
  • Douglas Longshore
  • Samuel A. Bozzette
Populations At Risk

DOI: 10.1046/j.1525-1497.2001.016009625.x

Cite this article as:
Turner, B.J., Fleishman, J.A., Wenger, N. et al. J GEN INTERN MED (2001) 16: 625. doi:10.1046/j.1525-1497.2001.016009625.x

Abstract

OBJECTIVE: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use.

DESIGN: Prospective population-based probability sample of 2,267 (representing 213,308) HIV-infected persons in care in the United States in early 1996.

MEASUREMENTS: Self-reported ART from first (January 1997–July 1997) to second (August 1997–January 1998) follow-up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first follow-up interview. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART.

RESULTS: Of our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR, 0.74; CI, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97), severe drug abuse (AOR, 0.52; CI, 0.32 to 0.87), and HIV risk from injection drug use (AOR, 0.55; CI, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART (AOR, 1.57; CI, 1.11 to 2.08).

CONCLUSIONS: Drug abuse-related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy.

Key words

anti-HIV agents substance-related disorders substance abuse intravenous drug abuse mental disorders HIV infections 

Copyright information

© Blackwell Science Inc 2001

Authors and Affiliations

  • Barbara J. Turner
    • 1
  • John A. Fleishman
    • 2
  • Neil Wenger
    • 3
  • Andrew S. London
    • 7
  • M. Audrey Burnam
    • 4
  • Martin F. Shapiro
    • 3
    • 4
  • Eric G. Bing
    • 6
  • Michael D. Stein
    • 8
  • Douglas Longshore
    • 4
  • Samuel A. Bozzette
    • 4
    • 5
  1. 1.the Division of General Internal Medicine, Department of MedicineUniversity of PennsylvaniaPhiladelphia
  2. 2.the Agency for Healthcare Research and QualityRockville
  3. 3.the University of California at Los AngelesLos Angeles
  4. 4.the RAND Health ProgramSanta Monica
  5. 5.the University of California-San Diego, and the Veterans Affairs San Diego Health SystemSan Diego
  6. 6.Center for AIDS Research, Education, and Services and Collaborative Alcohol Research CenterCharles R. Drew University of Medicine and ScienceLos Angeles
  7. 7.the Department of SociologyKent State UniversityKent
  8. 8.the Division of General Internal MedicineRhode Island HospitalProvidence

Personalised recommendations