, 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

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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.

The HIV Cost and Services Utilization Study was conducted under cooperative agreement HS08578 (MF Shapiro, Pl; SA Bozzette, Co-Pl) between RAND and the Agency for Health Care Policy and Research. Substantial additional support for this agreement was provided by the National Institute on Drug Abuse, the National Institute for Mental Health, and the Health Resources and Services Administration. Dr. Bing received support for this study from the National Institute for Mental Health as a UCLA Faculty Scholar in Mental Health Services Research (MH00990), the California Universitywide AIDS Research Program and the NIH Office of Research on Minority Health through the National Institute on Alcohol Abuse and Alcoholism (AA11899). Additional support was provided by the Robert Wood Johnson Foundation, Merck and Company Inc, Glaxo-Wellcome, and the National Institute on Aging. Dr. Bozzette is a Health Services Research and Development Senior Research Associate at the Department of Veterans Affairs.