Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362.

TitleAssociation of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362.
Publication TypeJournal Article
Year of Publication2011
AuthorsCohn SE, Jiang H, J McCutchan A, Koletar SL, Murphy RL, Robertson KR, de St Maurice AM, Currier JS, Williams PL
JournalAIDS Care
Volume23
Issue6
Pagination775-85
Date Published2011 Jun
ISSN1360-0451
KeywordsAdult, Alcohol-Related Disorders, Anti-Retroviral Agents, Cross-Sectional Studies, Disease Progression, Female, HIV Infections, Humans, Male, Medication Adherence, Middle Aged, Prognosis, Risk Factors, RNA, Viral, Socioeconomic Factors, Substance-Related Disorders, Surveys and Questionnaires, Treatment Outcome, Viral Load
Abstract

Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997 and 1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p=0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p=0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR = 2.11, p=0.08), but was still suggestive of a possible adherence-independent mechanism of harm. This study highlights the need to continuously screen and treat patients for drug use as a part of ongoing HIV care.

DOI10.1080/09540121.2010.525617
Alternate JournalAIDS Care
PubMed ID21293986
PubMed Central IDPMC3095689
Grant List1U01 AI 69474 / AI / NIAID NIH HHS / United States
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