Advertisement

Journal of General Internal Medicine

, Volume 17, Issue 5, pp 377–381 | Cite as

Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users

  • Julia H. Arnsten
  • Penelope A. Demas
  • Richard W. Grant
  • Marc N. Gourevitch
  • Homayoon Farzadegan
  • Andrea A. Howard
  • Ellie E. Schoenbaum
Brief Reports

Abstract

Despite a burgeoning literature on adherence to HIV therapies, few studies have examined the impact of ongoing drug use on adherence and viral suppression, and none of these have utilized electronic monitors to quantify adherence among drug users. We used 262 electronic monitors to measure adherence with all antiretrovirals in 85 HIV-infected current and former drug users, and found that active cocaine use, female gender, not receiving Social Security benefits, not being married, screening positive for depression, and the tendency to use alcohol or drugs to cope with stress were all significantly associated with poor adherence. The strongest predictor of poor adherence and, in turn, failure to maintain viral suppression, was active cocaine use. Overall adherence among active cocaine users was 27%, compared to 68% among subjects who reported no cocaine use during the 6-month study period. Consequently, 13% of active cocaine users maintained viral suppression, compared to 46% of nonusers. Interventions to improve adherence should focus on reducing cocaine use, developing adaptive coping skills, and identifying and treating depression.

Key Words

adherence drug users antiretroviral therapy electronic monitors 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2000;12(2).Google Scholar
  2. 2.
    Celentano DD, Galai N, Sethi AK, et al. Time to initiating antiretroviral therapy among HIV-infected drug users. AIDS. 2001;15:1707–15.PubMedCrossRefGoogle Scholar
  3. 3.
    Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and services utilization study. JAMA. 1999;281:2305–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Strathdee SA, Palepu A, Cornelisse PG, et al. Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998;280:547–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV infection. J Acquire Immune Defic Syndr. 2001;27:251–9.Google Scholar
  6. 6.
    Haubrich RH, Little S, Currier JS, Forthal DN, Kemper C. The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. AIDS. 1999;13:1099–107.PubMedCrossRefGoogle Scholar
  7. 7.
    Gifford AL, Bormann JE, Shively MJ, Wright BC, Richman DD, Bozzette SA. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. J Acquir Immune Defic Syndr. 2000;23:386–95.PubMedGoogle Scholar
  8. 8.
    Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: A theoretically based approach. J Pers Soc Psychchol. 1989;56:267–83.CrossRefGoogle Scholar
  9. 9.
    Singh N, Berman SM, Swindells S, et al. Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. Clin Infect Dis. 1999;29:824–30.PubMedGoogle Scholar
  10. 10.
    Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz H. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13:1763–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care. 2000;12:255–66.PubMedCrossRefGoogle Scholar
  12. 12.
    Stein MD, Rich JD, Maksad J, et al. Adherence to antiretroviral therapy among HIV-infected methadone patients: effect of ongoing illicit drug use. Am J Drug Alcohol Abuse. 2000;26:195–205.PubMedCrossRefGoogle Scholar
  13. 13.
    Johnston Roberts K, Mann T. Barriers to antiretroviral medication adherence in HIV-infected women. AIDS Care. 2000;12:377–86.CrossRefGoogle Scholar
  14. 14.
    Turner BJ, Newschaffer CJ, Zhang D, Cosler L, Hauck WW. Antiretroviral use and pharmacy-based measurement of adherence in postpartum HIV-infected women. Med Care. 2000;38:911–25.PubMedCrossRefGoogle Scholar
  15. 15.
    Moore J, Schuman P, Schoenbaum EE, Boland B, Solomon L, Smith DK. Severe adverse life events and depressive symptoms among women with, or at risk for, HIV infection in four cities in the United States of America. AIDS. 1999;13:2459–68.PubMedCrossRefGoogle Scholar
  16. 16.
    Avants SK, Margolin A, Warburton LA, Hawkins KA, Shi J. Predictors of nonadherence to HIV-related medication regimens during methadone stabilization. Am J Addict. 2001;10:69–78.PubMedCrossRefGoogle Scholar
  17. 17.
    Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14:357–66.PubMedCrossRefGoogle Scholar
  18. 18.
    Kastrissios H, Suarez JR, Katzenstein D, Girard P, Sheiner LB, Blaschke TF. Characterizing patterns of drug-taking behavior with a multiple drug regimen in an AIDS clinical trial. AIDS. 1998;12:2295–303.PubMedCrossRefGoogle Scholar
  19. 19.
    Liu H, Golin C, Miller LG, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med. 2001;134:968–77.PubMedGoogle Scholar
  20. 20.
    McNabb J, Ross JW, Abriola K, Turley C, Nightingale CH, Nicolau DP. Adherence to highly active antiretroviral therapy predicts virologic outcome at an inner-city HIV clinic. Clin Infect Dis. 2001;33:700–5.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Julia H. Arnsten
    • 1
    • 2
    • 3
  • Penelope A. Demas
    • 1
  • Richard W. Grant
    • 1
  • Marc N. Gourevitch
    • 1
    • 2
    • 3
  • Homayoon Farzadegan
    • 4
  • Andrea A. Howard
    • 1
    • 2
  • Ellie E. Schoenbaum
    • 1
    • 2
  1. 1.the AIDS Research Program, Department of Epidemiology and Social MedicineMontefiore Medical Center and Albert Einstein College of MedicineBronx
  2. 2.the Department of MedicineMontefiore Medical Center and Albert Einstein College of MedicineBronx
  3. 3.the Division of Substance Abuse, Department of Psychiatry and Behavioral SciencesMontefiore Medical Center and Albert Einstein College of MedicineBronx
  4. 4.the Department of EpidemiologyJohns Hopkins University School of Hygiene and Public HealthBaltimore

Personalised recommendations