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. 2015 Apr 18:15:193.
doi: 10.1186/s12879-015-0913-0.

Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis

Pouya Azar  1 , Evan Wood  2   3 , Paul Nguyen  4 , Maxo Luma  5 , Julio Montaner  6   7 , Thomas Kerr  8   9 , M-J Milloy  10   11
Affiliations

Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis

Pouya Azar et al. BMC Infect Dis. .

Abstract

Background: Among people living with HIV/AIDS, illicit drug use is a risk for sub-optimal treatment outcomes. However, few studies have examined the relative contributions of different patterns of drug use on adherence to antiretroviral therapy (ART). We sought to estimate the effect of different types of illicit drug use on adherence in a setting of universal free HIV/AIDS treatment and care.

Methods: Using data from ongoing prospective cohorts of HIV-positive illicit drug users linked to comprehensive pharmacy dispensation records in Vancouver, Canada, we examined factors associated with ≥95% prescription refill adherence using generalized estimating equations (GEE) logistic regression.

Results: Between 1996 and 2013, 692 ART-exposed individuals were followed for a median of 42.7 months (Interquartile Range: 29.1-71.7). In multivariable GEE analyses, heroin injection (Adjusted Odds Ratio [AOR] = 0.75, 95% Confidence Interval [CI]: 0.66-0.85) as well as cocaine injection (AOR = 0.80, 95% CI: 0.72-0.90) were associated with lower likelihoods of optimal adherence. Methadone maintenance therapy (AOR = 1.88, 95% CI: 1.68-2.11) was associated with a greater likelihood of adherence.

Conclusions: Periods of heroin and cocaine injection appeared to have the most deleterious impact upon antiretroviral adherence. The findings point to the need for improved access to treatment for heroin use disorder, particularly methadone, and highlight the need to identify strategies to support ART adherence among cocaine injectors.

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Figures

Figure 1
Figure 1
Drug use patterns over time; Proportion of all participants reporting heroin injection, cocaine injection, crack cocaine smoking and amphetamine injection in the previous 180 days at each survey period (plus symbol), with 95% confidence intervals.
Figure 2
Figure 2
Antiretroviral adherence patterns over time; Median antiretroviral adherence rate achieved in the last 180 days among all participants at each survey period (diamond), with lower and upper quartiles.
See this image and copyright information in PMC

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