Prior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: adherence analysis A5084.

TitlePrior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: adherence analysis A5084.
Publication TypeJournal Article
Year of Publication2008
AuthorsCohn SE, Umbleja T, Mrus J, Bardeguez AD, Andersen JW, Chesney MA
JournalAIDS Patient Care STDS
Volume22
Issue1
Pagination29-40
Date Published2008 Jan
ISSN1557-7449
KeywordsAdolescent, Adult, Anti-HIV Agents, Female, HIV Infections, HIV-1, Humans, Male, Patient Compliance, Postpartum Period, Predictive Value of Tests, Pregnancy, Pregnancy Complications, Infectious, Prenatal Care, Risk-Taking, RNA, Viral, Street Drugs, Substance-Related Disorders, Surveys and Questionnaires, Vitamins
Abstract

Adherence to antiretroviral therapy (ART) in pregnancy is crucial to optimize its efficacy and minimize mother-to-child transmission. Our objective was to examine adherence patterns to ART and health behaviors during and after pregnancy among HIV-positive women enrolled in A5084, a prospective, observational, multisite study. Between 2002-2005, HIV-infected women between 20 and 34 weeks'gestation completed at least 1 self-reported adherence questionnaire antepartum (AP), and were followed through 12 weeks' postpartum (PP). Questionnaires also addressed tobacco, alcohol, and illicit drugs use. Adherence was defined as reporting not having missed any doses for more than 3 months. Exact McNemar's tests were used for paired binary data and exact logistic regression was used for predictors of nonadherence. We report on 149 women (55% black, 26% Hispanic, 32% less than 25 years, 9% with AIDS, 100% on ART). PP, 31 (21%) women stopped ART and 18 (12%) withdrew from the study. AP, 57% reported adherence to ART and PP, 45% (p = 0.03, n = 87). AP, 11% reported ongoing alcohol use and 23% tobacco use compared to 37% and 30% PP (p < 0.0001, n = 103; p = 0.07, n = 99, respectively). Although 39% ever used marijuana (n = 116) and 25% used illicit drugs (n = 107), few participants reported use during the study. In multivariate analyses, those who had ever used illicit drugs had 5.95 times higher odds (p = 0.002) and those who missed prenatal vitamins had 4.84 times higher odds (p = 0.001) of ART nonadherence. Women reporting a history of illicit drug use and/or having missed prenatal vitamins should be targeted for programs to enhance adherence to ART during pregnancy.

DOI10.1089/apc.2007.0053
Alternate JournalAIDS Patient Care STDS
PubMed ID18442305
Grant ListAI25859 / AI / NIAID NIH HHS / United States
AI25879 / AI / NIAID NIH HHS / United States
AI25883 / AI / NIAID NIH HHS / United States
AI25897 / AI / NIAID NIH HHS / United States
AI25903 / AI / NIAID NIH HHS / United States
AI25915 / AI / NIAID NIH HHS / United States
AI27658 / AI / NIAID NIH HHS / United States
AI27661 / AI / NIAID NIH HHS / United States
AI27665 / AI / NIAID NIH HHS / United States
AI32907 / AI / NIAID NIH HHS / United States
AI34853 / AI / NIAID NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
AI42845 / AI / NIAID NIH HHS / United States
HD33345 / HD / NICHD NIH HHS / United States
N01 HD33345 / HD / NICHD NIH HHS / United States
RR000080 / RR / NCRR NIH HHS / United States
RR00043 / RR / NCRR NIH HHS / United States
RR00044 / RR / NCRR NIH HHS / United States
RR00069 / RR / NCRR NIH HHS / United States
RR00096 / RR / NCRR NIH HHS / United States
UO1 AI38558 / AI / NIAID NIH HHS / United States
UO1 AI41089 / AI / NIAID NIH HHS / United States