AIDS and Behavior

, Volume 14, Issue 4, pp 731–747 | Cite as

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

  • Monica MaltaEmail author
  • Monica M. F. Magnanini
  • Steffanie A. Strathdee
  • Francisco I. Bastos
Original Paper


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.


HIV AIDS Adherence Drug use Meta-analysis 



Sincere thanks are due to the technical assistance of Dr. Edward Mills, from Toronto, Canada. Dr. Mills is a researcher and professor from the Centre for International Health and Human Rights Studies and from the Oxford University, who kindly guided us during our analysis using the StatsDirect software. Sincere thanks are also due to Dr. Chuck Cleland, statistician and researcher from the Institute for AIDS Research, National Development and Research Institutes from New York; and to Dr. Wolfgang Viechtbauer, professor from the Department of Methodology and Statistics, University of Maastricht, from the Netherlands. Both Dr. Cleland and Dr. Viechtbauer kindly answered to our doubts while using the R-software. Dr. Malta acknowledges support from the National Institute on Drug Abuse and the Inter-American Drug Abuse Control Commission (NIDA/CICAD Research Award). Dr. Strathdee acknowledges support from the Fogarty International Center, grant R25-TW007500.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Monica Malta
    • 1
    Email author
  • Monica M. F. Magnanini
    • 2
  • Steffanie A. Strathdee
    • 3
  • Francisco I. Bastos
    • 4
  1. 1.Social Science Department, Sergio Arouca School of Public Health (DCS/ENSP)Oswaldo Cruz FoundationRio de JaneiroBrazil
  2. 2.Institute of Public Health StudiesFederal University of Rio de Janeiro (IESC/UFRJ)Rio de JaneiroBrazil
  3. 3.Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine at University of CaliforniaSan Diego (UCSD) School of MedicineSan DiegoUSA
  4. 4.Health Information Laboratory, Center for Scientific and Technological Information (LIS/ICICT)Oswaldo Cruz FoundationRio de JaneiroBrazil

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