AIDS and Behavior

, Volume 17, Issue 1, pp 113–121 | Cite as

Medication Persistence of HIV-infected Drug Users on Directly Administered Antiretroviral Therapy

  • Eileen C. Ing
  • Jason W. Bae
  • Duncan Smith-Rohrberg Maru
  • Frederick L. Altice
Original Paper

Abstract

Patient and regimen persistence in HIV-infected drug users are largely unknown. We evaluated patterns of medication non-persistence among HIV-infected drug users enrolled in a prospective, 6-month randomized controlled trial of directly administered antiretroviral therapy (DAART). Medication-taking behavior was assessed via direct observation and MEMS data. Of 74 participants who initiated DAART, 59 (80%) subjects were non-persistent with medication for 3 or more consecutive days. Thirty-one participants (42%) had 2 or more episodes of non-persistence. Higher depressive symptoms were strongly associated with non-persistence episodes of ≥ 3 days (AOR: 17.4, P = 0.02) and ≥ 7 days AOR: 5.4, P = 0.04). High addiction severity (AOR 3.2, P = 0.03) was correlated with non-persistence ≥ 7 days, and injection drug use (AOR: 15.2, P = 0.02) with recurrence of non-persistence ≥ 3 days. Time to regimen change was shorter for NNRTI-based regimens compared to PI-based ones (HR: 3.0, P = 0.03). There was no significant association between patterns of patient non-persistence and virological outcomes.

Keywords

HIV Adherence Persistence Directly administered antiretroviral therapy Substance abuse Depression Addiction severity 

Notes

Acknowledgments

The authors would like to acknowledge the National Institutes on Drug Abuse (R01 DA13805) for funding this study and career development award for FLA (K24 DA 0170720). DSRM is a Global Health Equity Fellow at Brigham and Women’s Hospital. The funding sources played no role in the design of the study, data collection, analysis or interpretation of results or in the writing of the report. We would like to thank Paula Dellamura for administrative support. Most importantly, we would like to thank the research staff and the study participants who dedicated time and energy to make this research possible. Without their help, this research would not have been possible.

References

  1. 1.
    Altice FL, Friedland GH. The era of adherence to HIV therapy. Ann Intern Med. 1998;129(6):503–5.PubMedGoogle Scholar
  2. 2.
    Montaner JSG, Reiss P, Cooper D, et al. A randomized, double-blind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients. JAMA. 1998;279(12):930–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Bangsberg DR, Charlebois ED, Grant RM, et al. High levels of adherence do not prevent accumulation of HIV drug resistance mutations. AIDS. 2003;17(13):1925–32.PubMedCrossRefGoogle Scholar
  4. 4.
    Bangsberg DR, Moss AR, Deeks SG. Paradoxes of adherence and drug resistance to HIV antiretroviral therapy. J Antimicrob Chemother. 2004;53(5):696–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Parienti JJ, Das-Douglas M, Massari V, et al. Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels. PLoS One. 2008;3(7):e2783.PubMedCrossRefGoogle Scholar
  6. 6.
    Parienti JJ, Ragland K, Lucht F, et al. Average adherence to boosted protease inhibitor therapy, rather than the pattern of missed doses, as a predictor of HIV RNA replication. Clin Infect Dis. 2010;50(8):1192–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Cramer JA, Roy A. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Burke JP, Sander S, Shah H, Zarotsky V, Henk H. Impact of persistence with antiplatelet therapy on recurrent ischemic stroke and predictors of nonpersistence among ischemic stroke survivors. Curr Med Res Opin. 2010;26(5):1023–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Contreras-Yanez I, Cabiedes J, Villa AR, Rull-Gabayet M, Pascual-Ramos V. Persistence on therapy is a major determinant of patient-, physician- and laboratory- reported outcomes in recent-onset rheumatoid arthritis patients. Clin Exp Rheumatol. 2010;28(5):748–51.PubMedGoogle Scholar
  10. 10.
    Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. Jama. 2002;288(4):455–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Hippisley-Cox J, Coupland C. Effect of statins on the mortality of patients with ischaemic heart disease: population based cohort study with nested case-control analysis. Heart. 2006;92(6):752–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Bae JW, Guyer W, Grimm K, Altice FL. Medication persistence in the treatment of HIV infection: a review of the literature and implications for future clinical care and research. AIDS. 2011;25(3):279–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Knobel H, Urbina O, Gonzalez A, et al. Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long-term follow-up. HIV Med. 2009;10(6):364–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Spacek LA, Shihab HM, Kamya MR, et al. Response to antiretroviral therapy in HIV-infected patients attending a public, urban clinic in Kampala, Uganda. Clin Infect Dis. 2006;42(2):252–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Oyugi JH, Byakika-Tusiime J, Ragland K, et al. Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda. AIDS. 2007;21(8):965–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Parienti JJ, Massari V, Descamps D, et al. Predictors of virologic failure and resistance in HIV-infected patients treated with nevirapine- or efavirenz-based antiretroviral therapy. Clin Infect Dis. 2004;38(9):1311–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Ananworanich J, Nuesch R, Le Braz M, et al. Failures of 1 week on, 1 week off antiretroviral therapies in a randomized trial. AIDS. 2003;17(15):F33–7.PubMedCrossRefGoogle Scholar
  18. 18.
    El-Sadr WM, Lundgren JD, Neaton JD, et al. CD4 + count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355(22):2283–96.PubMedCrossRefGoogle Scholar
  19. 19.
    Kranzer K, Ford N. Unstructured treatment interruption of antiretroviral therapy in clinical practice: a systematic review. Trop Med Int Health. 2011. doi: 10.1111/j.1365-3156.2011.02828.x.
  20. 20.
    Maru DS, Bruce RD, Walton M, et al. Initiation, adherence, and retention in a randomized controlled trial of directly administered antiretroviral therapy. AIDS Behav. 2008;12(2):284–93.PubMedCrossRefGoogle Scholar
  21. 21.
    Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. J Acquir Immune Defic Syndr. 2001;27(3):251–9.PubMedGoogle Scholar
  22. 22.
    Lucas GM, Gebo KA, Chaisson RE, Moore RD. Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS. 2002;16(5):767–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Kavasery R, Galai N, Astemborski J, et al. Nonstructured treatment interruptions among injection drug users in Baltimore, MD. J Acquir Immune Defic Syndr. 2009;50(4):360–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Arnsten JH, Demas PA, Grant RW, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002;17(5):377–81.PubMedGoogle Scholar
  25. 25.
    Altice FL, Maru DS, Bruce RD, Springer SA, Friedland GH. Superiority of directly administered antiretroviral therapy over self-administered therapy among HIV-infected drug users: a prospective, randomized, controlled trial. Clin Infect Dis. 2007;45(6):770–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Macalino GE, Hogan JW, Mitty JA, et al. A randomized clinical trial of community-based directly observed therapy as an adherence intervention for HAART among substance users. AIDS. 2007;21(11):1473–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Berg KM, Litwin A, Li X, Heo M, Arnsten JH. Directly observed antiretroviral therapy improves adherence and viral load in drug users attending methadone maintenance clinics: a randomized controlled trial. Drug Alcohol Depend. 2011;113(2–3):192–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Altice FL, Mezger JA, Hodges J. Developing a directly administered antiretroviral therapy intervention for HIV-infected drug users: implications for program replication. Clin Infect Dis. 2004;38(Suppl 5(s5)):S376–87.PubMedCrossRefGoogle Scholar
  29. 29.
    Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. J Subst Abuse Treat. 2007;32(2):189–98.PubMedCrossRefGoogle Scholar
  30. 30.
    Radloff LS. The CES-D Scale. Applied psychological measurement. 1977;1(3):385–401.CrossRefGoogle Scholar
  31. 31.
    Huba GJ, Melchior, LA, Staff of the Measurement Group, and HRSA/HAB’s SPNS Cooperative agreement steering committee Module 64: self-efficacy form 1996; http://www.TheMeasurementGroup.com. Accessed July 7 2011.
  32. 32.
    Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Statist Med. 2002;21(16):2409–19.CrossRefGoogle Scholar
  33. 33.
    Glass TR, De Geest S, Weber R, et al. Correlates of self-reported nonadherence to antiretroviral therapy in HIV-infected patients: the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2006;41(3):385–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Knobel H, Alonso J, Casado JL, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002;16(4):605–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Altice FL, Bruce RD, Lucas GM, et al. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 2011;56:S22–32.PubMedCrossRefGoogle Scholar
  36. 36.
    Zahari MM, Bae WH, Zainal NZ, Habil H, Kamarulzaman A, Altice FL. Psychiatric and substance abuse comorbidity among HIV seropositive and HIV seronegative prisoners in Malaysia. Am J Drug Alcohol Abuse. 2010;36(1):31–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376(9738):367–87.PubMedCrossRefGoogle Scholar
  38. 38.
    Lima VD, Geller J, Bangsberg DR, et al. The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS. 2007;21(9):1175–83.PubMedCrossRefGoogle Scholar
  39. 39.
    Tsai AC, Weiser SD, Petersen ML, Ragland K, Kushel MB, Bangsberg DR. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch Gen Psychiatry. 2010;67(12):1282–90.PubMedCrossRefGoogle Scholar
  40. 40.
    Braithwaite RS, Kozal MJ, Chang CC, et al. Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies. AIDS. 2007;21(12):1579–89.PubMedCrossRefGoogle Scholar
  41. 41.
    MacArthur RD, Novak RM, Peng G. A comparison of three highly active antiretroviral treatment strategies consisting of non-nucleoside reverse transcriptase inhibitors, protease inhibitors, or both in the presence of nucleoside reverse transcriptase inhibitors as initial therapy (CPCRA 058 FIRST Study): a long-term randomised trial. Lancet. 2006;368(9553):2125–35.PubMedCrossRefGoogle Scholar
  42. 42.
    Springer SA, Friedland GH, Doros G, Pesanti E, Altice FL. Antiretroviral treatment regimen outcomes among HIV-infected prisoners. HIV Clin Trials. 2007;8(4):205–12.PubMedCrossRefGoogle Scholar
  43. 43.
    Willig JH, Abroms S, Westfall AO, et al. Increased regimen durability in the era of once-daily fixed-dose combination antiretroviral therapy. AIDS. 2008;22(15):1951–60.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Eileen C. Ing
    • 1
  • Jason W. Bae
    • 2
  • Duncan Smith-Rohrberg Maru
    • 2
    • 3
    • 4
  • Frederick L. Altice
    • 5
    • 6
  1. 1.Butler Hospital/Alpert Medical School of Brown UniversityProvidenceUSA
  2. 2.Section of Infectious DiseasesYale University School of MedicineNew HavenUSA
  3. 3.Department of MedicineBrigham and Women’s HospitalBostonUSA
  4. 4.Department of MedicineChildren’s Hospital of BostonBostonUSA
  5. 5.Section of Infectious Diseases, Department of MedicineYale University School of MedicineNew HavenUSA
  6. 6.Division of Epidemiology of Microbial DiseasesYale School of Public HealthNew HavenUSA

Personalised recommendations