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.
- Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons
Journal of General Internal Medicine
Volume 16, Issue 9 , pp 625-633
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- Print ISSN
- Online ISSN
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- anti-HIV agents
- substance-related disorders
- substance abuse
- intravenous drug abuse
- mental disorders
- HIV infections
- Industry Sectors
- Author Affiliations
- 1. the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pa
- 2. the Agency for Healthcare Research and Quality, Rockville, Md
- 3. the University of California at Los Angeles, Los Angeles, Calif
- 4. the Department of Sociology, Kent State University, Kent, Ohio
- 5. the RAND Health Program, Santa Monica, Calif
- 6. Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science, Los Angeles, Calif
- 7. the Division of General Internal Medicine, Rhode Island Hospital, Providence, RI
- 8. the University of California-San Diego, and the Veterans Affairs San Diego Health System, San Diego, Calif