Effects of Drug Abuse and Mental Disorders on Use and Type of Antiretroviral Therapy in HIV-infected Persons

Authors

  • Barbara J. Turner MD, MSEd,

    Corresponding author
    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • John A. Fleishman PhD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • Neil Wenger MD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • Andrew S. London PhD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • M. Audrey Burnam PhD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • Martin F. Shapiro MD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • Eric G. Bing MD, PhD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • Michael D. Stein MD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • Douglas Longshore PhD,

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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  • Samuel A. Bozzette MD

    1. From the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania (BJT), Philadelphia, Pa; the Agency for Healthcare Research and Quality (JAF), Rockville, Md; the University of California at Los Angeles (NW, MFS), Los Angeles, Calif; the RAND Health Program (MAB, SAB, DL, MFS), Santa Monica, Calif; the University of California–San Diego, and the Veterans Affairs San Diego Health System (SAB), San Diego, Calif; Center for AIDS Research, Education, and Services and Collaborative Alcohol Research Center, Charles R. Drew University of Medicine and Science (EGB), Los Angeles, Calif; the Department of Sociology, Kent State University (ASL), Kent, Ohio; and the Division of General Internal Medicine, Rhode Island Hospital (MDS), Providence, RI.
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Address correspondence and reprint requests to Dr. Turner: University of Pennsylvania, 1122 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104 (e-mail: bturner@mail.med.upenn.edu).

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.

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