Presented in part at the Seventh Conference on Retroviruses and Opportunistic Infections, San Francisco, Calif, January, 2000, and the 22nd annual meeting of the Society of General Internal Medicine, San Francisco, Calif, May, 2000.
Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug Users
Article first published online: 31 MAY 2002
Journal of General Internal Medicine
Volume 17, Issue 5, pages 377–381, May 2002
How to Cite
Arnsten, J. H., Demas, P. A., Grant, R. W., Gourevitch, M. N., Farzadegan, H., Howard, A. A. and Schoenbaum, E. E. (2002), Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug Users. Journal of General Internal Medicine, 17: 377–381. doi: 10.1046/j.1525-1497.2002.10644.x
- Issue published online: 31 MAY 2002
- Article first published online: 31 MAY 2002
- drug users;
- antiretroviral therapy;
- electronic monitors
Despite a burgeoning literature on adherence to HIV therapies, few studies have examined the impact of ongoing drug use on adherence and viral suppression, and none of these have utilized electronic monitors to quantify adherence among drug users. We used 262 electronic monitors to measure adherence with all antiretrovirals in 85 HIV-infected current and former drug users, and found that active cocaine use, female gender, not receiving Social Security benefits, not being married, screening positive for depression, and the tendency to use alcohol or drugs to cope with stress were all significantly associated with poor adherence. The strongest predictor of poor adherence and, in turn, failure to maintain viral suppression, was active cocaine use. Overall adherence among active cocaine users was 27%, compared to 68% among subjects who reported no cocaine use during the 6-month study period. Consequently, 13% of active cocaine users maintained viral suppression, compared to 46% of nonusers. Interventions to improve adherence should focus on reducing cocaine use, developing adaptive coping skills, and identifying and treating depression.