Article

Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362.

Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
AIDS Care (impact factor: 1.6). 02/2011; 23(6):775-85. DOI:10.1080/09540121.2010.525617 pp.775-85
Source: PubMed

ABSTRACT Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997 and 1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p=0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p=0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR = 2.11, p=0.08), but was still suggestive of a possible adherence-independent mechanism of harm. This study highlights the need to continuously screen and treat patients for drug use as a part of ongoing HIV care.

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Keywords

2.5 times higher risk
 
24% amphetamines
 
4% amphetamines
 
643 participants
 
AIDS patients
 
alcohol use
 
ART doses
 
ART non-adherence
 
continuously screen
 
Cox regression models
 
drug use
 
HIV-infected populations
 
measures generalized
 
multicenter observational study
 
new AIDS diagnosis
 
Ongoing drug use
 
ongoing HIV care
 
possible adherence-independent mechanism
 
study follow-up
 
worse prognosis
 

Susan E Cohn