Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug Users

Authors

  • Julia H. Arnsten MD, MPH,

    Corresponding author
    1. Received from the AIDS Research Program, Department of Epidemiology and Social Medicine (JHA, PAD, RWG, MNG, AAH, EES), the Department of Medicine (JHA, MNG, AAH, EES), and the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (JHA, MNG), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health (HF), Baltimore, Md.
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  • Penelope A. Demas PhD,

    1. Received from the AIDS Research Program, Department of Epidemiology and Social Medicine (JHA, PAD, RWG, MNG, AAH, EES), the Department of Medicine (JHA, MNG, AAH, EES), and the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (JHA, MNG), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health (HF), Baltimore, Md.
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  • Richard W. Grant MD,

    1. Received from the AIDS Research Program, Department of Epidemiology and Social Medicine (JHA, PAD, RWG, MNG, AAH, EES), the Department of Medicine (JHA, MNG, AAH, EES), and the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (JHA, MNG), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health (HF), Baltimore, Md.
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  • Marc N. Gourevitch MD, MPH,

    1. Received from the AIDS Research Program, Department of Epidemiology and Social Medicine (JHA, PAD, RWG, MNG, AAH, EES), the Department of Medicine (JHA, MNG, AAH, EES), and the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (JHA, MNG), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health (HF), Baltimore, Md.
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  • Homayoon Farzadegan PhD,

    1. Received from the AIDS Research Program, Department of Epidemiology and Social Medicine (JHA, PAD, RWG, MNG, AAH, EES), the Department of Medicine (JHA, MNG, AAH, EES), and the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (JHA, MNG), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health (HF), Baltimore, Md.
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  • Andrea A. Howard MD,

    1. Received from the AIDS Research Program, Department of Epidemiology and Social Medicine (JHA, PAD, RWG, MNG, AAH, EES), the Department of Medicine (JHA, MNG, AAH, EES), and the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (JHA, MNG), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health (HF), Baltimore, Md.
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  • Ellie E. Schoenbaum MD

    1. Received from the AIDS Research Program, Department of Epidemiology and Social Medicine (JHA, PAD, RWG, MNG, AAH, EES), the Department of Medicine (JHA, MNG, AAH, EES), and the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (JHA, MNG), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health (HF), Baltimore, Md.
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  • 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.

Address correspondence and requests for reprints to Dr. Arnsten: AIDS Research Program, Montefiore Medical Center, 111 East 210 St., Bronx, NY 10467 (e-mail: jarnsten@montefiore.org).

Abstract

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.

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