Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons

Abstract

OBJECTIVE: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use. DESIGN: Prospective population‐based probability sample of 2,267 (representing 213,308) HIV‐infected persons in care in the United States in early 1996. MEASUREMENTS: Self‐reported ART from first (January 1997–July 1997) to second (August 1997–January 1998) follow‐up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first follow‐up interview. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART. RESULTS Of our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR, 0.74; CI, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97), severe drug abuse (AOR, 0.52; CI, 0.32 to 0.87), and HIV risk from injection drug use (AOR, 0.55; CI, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART (AOR, 1.57; CI, 1.11 to 2.08). CONCLUSIONS: Drug abuse‐related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy.

Are online support groups always beneficial? A qualitative exploration of the empowering and disempowering processes of participation within HIV/AIDS-related online support groups

“…In addition to background information (see Table 1), a series of questions were asked to capture the level of online support group use (Houston, Copper, & Ford, 2002;Nonnecke, Andrews, & Preece, 2006;Turner et al, 2001) (see Table 2). In order to gain a richer insight into the experience of using HIV/AIDS-related online support groups, participants were then asked to respond to a series of open-ended questions which explored: reasons for participating in/accessing online support groups, differences between support obtained online versus that from the face to face context, perceived advantages and disadvantages of participating in/accessing online support groups, and impact of online support group use on disease management.…”

Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes

“…40 We assessed substance use with the Addiction Severity Index-Lite 41 and calculated substance use severity scores using a weighted algorithm validated as a predictor of ARV adherence. 42 Patients rated their quality of life using a single, global item with a 100 mm visual analogue scale. 43 They reported depressive symptoms using the 10-item Center for Epidemiologic Studies depression scale (CES-D).…”

Monitoring Drug Use Among HIV/AIDS Patients in Brazil: Should we Combine Self-Report and Urinalysis?

“…Approximately half of a national sample of HIV-infected Americans reported a history of substance abuse [1]. In a large study (611 patients from 8 clinical care sites) in the United States, the most common drugs used were marijuana (12%) and crack-cocaine (5%).…”