Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study

doi:10.1186/s12879-016-1749-y

. 2016 Aug 27;16(1):455.

doi: 10.1186/s12879-016-1749-y.

Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study

Kanna Hayashi^{1

2}, Evan Wood^{1

2}, Thomas Kerr^{1

2}, Huiru Dong¹, Paul Nguyen¹, Cathy M Puskas^{1

3}, Silvia Guillemi¹, Julio S G Montaner^{1

2}, Michael-John Milloy^{4

5}

Affiliations

¹ British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
² Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
³ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
⁴ British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.
⁵ Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.

PMID: 27568002
PMCID: PMC5002322
DOI: 10.1186/s12879-016-1749-y

Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study

Kanna Hayashi et al. BMC Infect Dis. 2016.

. 2016 Aug 27;16(1):455.

doi: 10.1186/s12879-016-1749-y.

Authors

Kanna Hayashi^{1

2}, Evan Wood^{1

2}, Thomas Kerr^{1

2}, Huiru Dong¹, Paul Nguyen¹, Cathy M Puskas^{1

3}, Silvia Guillemi¹, Julio S G Montaner^{1

2}, Michael-John Milloy^{4

5}

Affiliations

¹ British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
² Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
³ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
⁴ British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.
⁵ Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.

PMID: 27568002
PMCID: PMC5002322
DOI: 10.1186/s12879-016-1749-y

Abstract

Background: Crack cocaine use is known to contribute to poor adherence to antiretroviral medications; however, little is known about facilitators of or barriers to effective HIV treatment use among HIV-infected crack cocaine users. We sought to identify correlates of optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA viral load (pVL) suppression among this population.

Methods: Data from a prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, were linked to comprehensive HIV clinical monitoring and pharmacy dispensation records. We used multivariable generalized linear mixed-effects modelling to longitudinally identify factors associated with ≥95 % adherence to pharmacy refills for antiretroviral medications and pVL <50 copies/mL among crack cocaine users exposed to highly-active antiretroviral therapy (HAART).

Results: Among 438 HAART-exposed crack cocaine users between 2005 and 2013, 240 (54.8 %) had ≥95 % pharmacy refill adherence in the previous 6 months at baseline. In multivariable analyses, homelessness (adjusted odds ratio [AOR]: 0.58), ≥daily crack cocaine smoking (AOR: 0.64), and ≥ daily heroin use (AOR: 0.43) were independently associated with optimal pharmacy refill adherence (all p < 0.05). The results for pVL non-detectability were consistent with those of medication adherence, except that longer history of HAART (AOR: 1.06), receiving a single tablet-per-day regimen (AOR: 3.02) and participation in opioid substitution therapies was independently associated with pVL non-detectability (AOR: 1.55) (all p < 0.05).

Conclusions: Homelessness, and daily crack cocaine and/or heroin use were independently and negatively associated with optimal HAART-related outcomes. With the exception of opioid substitution therapies, no addiction treatment modalities assessed appeared to facilitate medication adherence or viral suppression. Evidence-based treatment options for crack cocaine use that also confer benefits to HAART need to be developed.

Keywords: ART adherence; Addiction treatment; Crack cocaine; Plasma HIV-1 RNA viral load suppression.

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References

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[1] Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis. 2013;26(1):17–25. doi: 10.1097/QCO.0b013e32835ba6b1. - DOI - PubMed

[2] Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis. 2013;26(1):17–25. doi: 10.1097/QCO.0b013e32835ba6b1. - DOI - PubMed

[3] Montaner JS, Lima VD, Barrios R, Yip B, Wood E, Kerr T, et al. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet. 2010;376(9740):532–9. doi: 10.1016/S0140-6736(10)60936-1. - DOI - PMC - PubMed

[4] Montaner JS, Lima VD, Barrios R, Yip B, Wood E, Kerr T, et al. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet. 2010;376(9740):532–9. doi: 10.1016/S0140-6736(10)60936-1. - DOI - PMC - PubMed

[5] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. doi: 10.1056/NEJMoa1105243. - DOI - PMC - PubMed

[6] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. doi: 10.1056/NEJMoa1105243. - DOI - PMC - PubMed

[7] Des Jarlais DC, Mcknight C, Arasteh K, Feelemyer J, Perlman DC, Hagan H, et al. A perfect storm: crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City. Subst Use Misuse. 2014;49(7):783–92. doi: 10.3109/10826084.2014.880176. - DOI - PMC - PubMed

[8] Des Jarlais DC, Mcknight C, Arasteh K, Feelemyer J, Perlman DC, Hagan H, et al. A perfect storm: crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City. Subst Use Misuse. 2014;49(7):783–92. doi: 10.3109/10826084.2014.880176. - DOI - PMC - PubMed

[9] Wechsberg WM, Golin C, El-Bassel N, Hopkins J, Zule W. Current interventions to reduce sexual risk behaviors and crack cocaine use among HIV-infected individuals. Curr HIV/AIDS Rep. 2012;9(4):385–93. doi: 10.1007/s11904-012-0131-y. - DOI - PMC - PubMed

[10] Wechsberg WM, Golin C, El-Bassel N, Hopkins J, Zule W. Current interventions to reduce sexual risk behaviors and crack cocaine use among HIV-infected individuals. Curr HIV/AIDS Rep. 2012;9(4):385–93. doi: 10.1007/s11904-012-0131-y. - DOI - PMC - PubMed

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Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study

Affiliations

Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study

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