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


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 


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Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Julia H. Arnsten
    • 1
    • 2
    • 3
    Email author
  • 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

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