Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To identify the effects of substance abuse status (active, former, and never) on utilization of highly active antiretroviral therapy (HAART), medication adherence, and virologic and immunologic responses to therapy. Design: Prospective cohort study of 764 HIV-1-infected patients who attended an urban HIV clinic and participated in a standardized interview. Main Outcome Measures: Past utilization of HAART, self-reported nonadherence with antiretroviral therapy, and changes in HIV-1 RNA level and CD4+ lymphocyte count relative to prior peak and nadir, respectively. Results: Forty-four percent of active drug users failed to utilize HAART compared with 22% of former drug users and 18% of non-drug users (p < .001 for both comparisons). Among participants who were taking antiretroviral therapy when interviewed, active drug users were more likely to report medication nonadherence (34% vs. 24% of nonusers and 17% of former users), had a smaller median reduction in HIV-1 RNA from baseline (0.8 log10 copies/ml vs. 1.7 in nonusers and 1.6 in former users), and had smaller median increases in CD4+ lymphocyte count from baseline (65 cells/mm3 vs. 116 in nonusers and 122 in former users) (p < .05 for all comparisons with active users). Conclusions: Active drug use was strongly associated with underutilization of HAART, nonadherence, and inferior virologic and immunologic responses to therapy, whereas former drug users and non-drug users were similar in all outcomes. Effective strategies are needed that integrate HIV-1 and substance abuse treatments.

Original languageEnglish (US)
Pages (from-to)251-259
Number of pages9
JournalJournal of acquired immune deficiency syndromes
Volume27
Issue number3
DOIs
StatePublished - Jul 1 2001

Keywords

  • Antiretroviral therapy
  • CD4 lymphocyte count
  • HIV-1
  • Illicit drug use
  • Patient nonadherence
  • Viral load

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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