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Low Non-structured Antiretroviral Therapy Interruptions in HIV-Infected Persons Who Inject Drugs Receiving Multidisciplinary Comprehensive HIV Care at an Outpatient Drug Abuse Treatment Center

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Abstract

Continuous HIV treatment is necessary to ensure successful combined antiretroviral therapy (cART). The aim of this study was to evaluate the incidence of patient-initiated non-structured treatment interruptions in HIV-infected persons who inject drugs and who received a multidisciplinary comprehensive program, including medical HIV care, drug-dependence treatment and psychosocial support, at a drug outpatient addiction center. Non-structured treatment interruptions were defined as ≥30 consecutive days off cART without medical indication. During a median follow-up of 53.8 months, 37/132 (28 %) patients experienced the first non-structured treatment interruptions. The cumulative probability of cART interruption at 5 years was 31.2 % (95 % CI 22.4–40.0). Current drug use injection ≥1/day (HR 14.77; 95 % CI 5.90–36.96) and cART naive patients (HR 0.35, 95 % CI 0.14–0.93) were predictive factors for non-structured treatment interruptions. HIV care provided at a drug addiction center is a useful strategy to sustain continuous cART, however, drug abstinence is essential for the long-term maintenance of cART.

Resumen

El tratamiento continuado del VIH es necesario para garantizar la eficacia de la terapia antirretroviral combinada (TAR). El objetivo de este estudio fué evaluar la incidencia de las interrupciones no estructuradas de tratamiento iniciadas por el paciente en personas infectadas por el VIH usuarias de drogas intravenosas y que recibieron un programa multidisciplinario, incluyendo atención médica del VIH, tratamiento de las drogodependencias y apoyo psicosocial, en un centro ambulatorio de atención médica a la adicción de drogas. Las interrupciones no estructuradas fueron definidas como el abandono de la TAR ≥ 30 días consecutivos sin indicación médica. Durante una mediana de seguimiento de 53.8 meses, 37/132 (28 %) pacientes tuvieron una primera interrupción no estructurada de la TAR. La probabilidad acumulada de interrupción fué del 31.2 % (IC 95 %: 22.4-40.0) a los 5 años. El consumo de drogas inyectables ≥1/día (HR14.77; IC del 95 %: 5,90 a 36,96) y los pacientes naive a la TAR (HR 0.35; IC del 95 %: 0.14-0.93) fueron factores predictivos de interrupciones no estructuradas de la TAR. La atención médica del VIH proporcionada en un centro ambulatorio de atención médica a la adicción de drogas es una estrategia útil para conseguir el mantenimiento de la TAR, sin embargo, la abstinencia de drogas es esencial para el mantenimiento a largo plazo.

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Funding

This work was supported by grant from Instituto de Salud Carlos III (Red de Trastornos Adictivos, UE-FEDER 2012, RD12/0028/0009).

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Authors and Affiliations

  1. Institute of Neuropsychiatry and Addictions, Universitat Autònoma de Barcelona, Parc de Salut Mar, Barcelona, Spain

    Gabriel Vallecillo, Albert Roquer, Pilar Samos, Diana Martinez, Paula Karen Martires & Marta Torrens

  2. Department of Statistics and Operations Research, Parc de Recerca Biomédica de Barcelona PRBB, Barcelona, Spain

    Sergio Mojal

  3. Department of Pharmacy, Hospital del Mar., Barcelona, Spain

    Sonia Luque

Authors
  1. Gabriel Vallecillo
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  2. Sergio Mojal
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  3. Albert Roquer
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  7. Paula Karen Martires
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Correspondence to Gabriel Vallecillo.

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Vallecillo, G., Mojal, S., Roquer, A. et al. Low Non-structured Antiretroviral Therapy Interruptions in HIV-Infected Persons Who Inject Drugs Receiving Multidisciplinary Comprehensive HIV Care at an Outpatient Drug Abuse Treatment Center. AIDS Behav 20, 1068–1075 (2016). https://doi.org/10.1007/s10461-015-1211-y

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  • DOI: https://doi.org/10.1007/s10461-015-1211-y

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