Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis

Abstract

BackgroundAmong people living with HIV/AIDS, illicit drug use is a risk for sub-optimal treatment outcomes. However, few studies have examined the relative contributions of different patterns of drug use on adherence to antiretroviral therapy (ART). We sought to estimate the effect of different types of illicit drug use on adherence in a setting of universal free HIV/AIDS treatment and care.MethodsUsing data from ongoing prospective cohorts of HIV-positive illicit drug users linked to comprehensive pharmacy dispensation records in Vancouver, Canada, we examined factors associated with ≥95% prescription refill adherence using generalized estimating equations (GEE) logistic regression.ResultsBetween 1996 and 2013, 692 ART-exposed individuals were followed for a median of 42.7 months (Interquartile Range: 29.1–71.7). In multivariable GEE analyses, heroin injection (Adjusted Odds Ratio [AOR] = 0.75, 95% Confidence Interval [CI]: 0.66–0.85) as well as cocaine injection (AOR = 0.80, 95% CI: 0.72–0.90) were associated with lower likelihoods of optimal adherence. Methadone maintenance therapy (AOR = 1.88, 95% CI: 1.68–2.11) was associated with a greater likelihood of adherence.ConclusionsPeriods of heroin and cocaine injection appeared to have the most deleterious impact upon antiretroviral adherence. The findings point to the need for improved access to treatment for heroin use disorder, particularly methadone, and highlight the need to identify strategies to support ART adherence among cocaine injectors.

HIV treatment cascade in MSM, people who inject drugs, and sex workers

“…Recent studies have found that OST among PWID is associated with higher CD4+ cell count at ART initiation[71], ART initiation and access[83,84], ART medication adherence[85,86], decreases in ART discontinuation[87], and decreases in delayed care visits[88]. …”

Marijuana use and HIV treatment outcomes among PWH receiving care at an urban HIV clinic

“…Alcohol and other drug use are prevalent among persons living with HIV (PWH) and are barriers to optimal use of antiretroviral therapy (ART) and viral suppression [1–2]. Hazardous alcohol and drug use contribute to HIV disease progression both by reducing adherence to ART and by accelerating disease progression [1–5].…”

Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias

“…Por otro lado, en el presente estudio no se ha hallado asociación significativa entre el consumo de cannabis, cocaína o heroína y el deterioro de la adherencia terapéuti-ca, lo cual difiere globalmente de los hallazgos publicados previamente en la literatura en otros contextos (Hinkin et al, 2004;Azar et al, 2015). No obstante, la ausencia de relación entre el consumo de cannabis y el incumplimiento terapéutico ya ha sido señalada previamente por otros autores (Rosen et al, 2013;De Jong, Prentiss, McFarland, Machekano e Israelski, 2005).…”