TY - JOUR
T1 - Association of alcohol abuse and injection drug use with immunologic and virologic responses to HAART in HIV-positive patients from urban community health clinics
AU - Henrich, Timothy J.
AU - Lauder, Naudia
AU - Desai, Mayur M.
AU - Sofair, Andre N.
N1 - Funding Information:
Acknowledgments We would like to thank Sunanda Pejavar, Amber Schaub, Dania Lieberthal and Irina Magadina for the experienced help with chart reviews and data entry. Special appreciation goes to Amanda Durante, Ph.D. for her valuable input during the design and implementation of this study, as well as to the staff of the Yale Emerging Infections Program, the New Haven County Liver Study. We would also like to thank Jose Salvana M.D. of the Hill Health Center, Pamela E. Jackson, M.D. of the Fair Haven Community Health Center, and the medical records staff at the participating community health clinics. This project was funded by the New Haven County Liver Study. Dr. Desai is supported by a career development award (MRP 02-259-2) from the Veterans Affairs Health Services Research and Development Service.
Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2008/4
Y1 - 2008/4
N2 - The purpose of this study is to examine the association of alcohol abuse and injection drug use (IDU) with the immunologic and virologic responses to highly active antiretroviral treatment (HAART) in urban community health clinics. The medical records of 293 HIV-infected adult patients who visited either of two urban health clinics in New Haven, Connecticut, from June 2003 to December 2004 were retrospectively reviewed. Changes in mean CD4 lymphocyte counts and undetectable viral loads were compared before and after the initiation of HAART for patients categorized into one of four substance abuse groups: history of neither alcohol abuse nor IDU, alcohol abuse only, IDU only, or both. Unadjusted mean improvements in CD4 count for the four groups were 136, 97, 20, and 27, respectively. In a linear regression model adjusted for age, gender, and baseline CD4 count, history of IDU only (P = 0.037) and a combination of alcohol abuse and IDU (P = 0.038) were associated with a lesser increase in CD4 count after HAART compared with those with neither alcohol nor IDU. No significant associations were found between substance abuse history and changes in detectable viral load. Our results show that many patients at urban health clinics have a history of either injection drug use or alcohol abuse, and that injection drug use is negatively associated with the immunologic response to HAART in urban HIV-infected individuals. This study highlights the importance for clinicians of understanding the negative associations of substance abuse with the treatment response of HIV-infected patients at urban health centers.
AB - The purpose of this study is to examine the association of alcohol abuse and injection drug use (IDU) with the immunologic and virologic responses to highly active antiretroviral treatment (HAART) in urban community health clinics. The medical records of 293 HIV-infected adult patients who visited either of two urban health clinics in New Haven, Connecticut, from June 2003 to December 2004 were retrospectively reviewed. Changes in mean CD4 lymphocyte counts and undetectable viral loads were compared before and after the initiation of HAART for patients categorized into one of four substance abuse groups: history of neither alcohol abuse nor IDU, alcohol abuse only, IDU only, or both. Unadjusted mean improvements in CD4 count for the four groups were 136, 97, 20, and 27, respectively. In a linear regression model adjusted for age, gender, and baseline CD4 count, history of IDU only (P = 0.037) and a combination of alcohol abuse and IDU (P = 0.038) were associated with a lesser increase in CD4 count after HAART compared with those with neither alcohol nor IDU. No significant associations were found between substance abuse history and changes in detectable viral load. Our results show that many patients at urban health clinics have a history of either injection drug use or alcohol abuse, and that injection drug use is negatively associated with the immunologic response to HAART in urban HIV-infected individuals. This study highlights the importance for clinicians of understanding the negative associations of substance abuse with the treatment response of HIV-infected patients at urban health centers.
KW - Alcohol abuse
KW - Antiretroviral therapy
KW - HIV infection
KW - Intravenous drug use
KW - Substance abuse
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U2 - 10.1007/s10900-007-9069-1
DO - 10.1007/s10900-007-9069-1
M3 - Article
C2 - 18046634
AN - SCOPUS:39149088032
SN - 0094-5145
VL - 33
SP - 69
EP - 77
JO - Journal of Community Health
JF - Journal of Community Health
IS - 2
ER -