Improved adherence to modern antiretroviral therapy among HIV-infected injecting drug users
Version of Record online: 2 MAY 2012
© 2012 British HIV Association
Volume 13, Issue 10, pages 596–601, November 2012
How to Cite
Mann, B., Milloy, M.-J., Kerr, T., Zhang, R., Montaner, J. and Wood, E. (2012), Improved adherence to modern antiretroviral therapy among HIV-infected injecting drug users. HIV Medicine, 13: 596–601. doi: 10.1111/j.1468-1293.2012.01021.x
- Issue online: 11 OCT 2012
- Version of Record online: 2 MAY 2012
- Manuscript Accepted: 20 MAR 2012
- US National Institutes of Health. Grant Number: R01DA021525
- Canadian Institutes of Health Research. Grant Numbers: MOP-79297, RAA-79918
- Michael Smith Foundation for Health Research
- antiretroviral therapy;
- injection drug users
Adherence to antiretroviral therapy (ART) among injecting drug users (IDUs) is often suboptimal, yet little is known about changes in patterns of adherence since the advent of highly active antiretroviral therapy in 1996. We sought to assess levels of optimal adherence to ART among IDUs in a setting of free and universal HIV care.
Data were collected through a prospective cohort study of HIV-positive IDUs in Vancouver, British Columbia. We calculated the proportion of individuals achieving at least 95% adherence in the year following initiation of ART from 1996 to 2009.
Among 682 individuals who initiated ART, the median age was 37 years (interquartile range 31–44 years) and 248 participants (36.4%) were female. The proportion achieving at least 95% adherence increased over time, from 19.3% in 1996 to 65.9% in 2009 (Cochrane–Armitage test for trend: P < 0.001). In a logistic regression model examining factors associated with 95% adherence, initiation year was statistically significant (odds ratio 1.08; 95% confidence interval 1.03–1.13; P < 0.001 per year after 1996) after adjustment for a range of drug use variables and other potential confounders.
The proportion of IDUs achieving at least 95% adherence during the first year of ART has consistently increased over a 13-year period. Although improved tolerability and convenience of modern ART regimens probably explain these positive trends, by the end of the study period a substantial proportion of IDUs still had suboptimal adherence, demonstrating the need for additional adherence support strategies.