Time to initiating highly active antiretroviral therapy among HIV-infected injection drug users.
OBJECTIVE
Studies have shown that HIV-infected injection drug users (IDUs) are less likely to receive antiretroviral therapy than non-drug users. We assess factors associated with initiating highly active antiretroviral therapy (HAART) in HIV-infected IDUs.


METHODS
A cohort study of IDUs carried out between 1 January 1996 and 30 June 1999 at a community-based study clinic affiliated to the Johns Hopkins University, Baltimore, Maryland. The participants were a total of 528 HIV-infected IDUs eligible for HAART based on CD4+ cell count. The main outcome measure was the time from treatment eligibility to first self-reported HAART use, as defined by the International AIDS Society-USA panel (IAS-USA) guidelines.


RESULTS
By 30 June 1999, 58.5% of participants had initiated HAART, most of whom switched from mono- or dual-combination therapy to a HAART regimen. Nearly one-third of treatment-eligible IDUs never received antiretroviral therapy. Cox proportional hazards regression showed that initiating HAART was independently associated with not injecting drugs, methadone treatment among men, having health insurance and a regular source of care, lower CD4+ cell count and a history of antiretroviral therapy.


CONCLUSIONS
Self-reported initiation of HAART is steadily increasing among IDUs who are eligible for treatment; however, a large proportion continues to use non-HAART regimens and many remain treatment-naive. Although both groups appear to have lower health care access and utilization, IDUs without a history of antiretroviral therapy use would have more treatment options available to them once they become engaged in HIV care.
Celentano
D D
DD
Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland 21205, USA. dcelenta@jhsph.edu
Galai
N
N
Sethi
A K
AK
Shah
N G
NG
Strathdee
S A
SA
Vlahov
D
D
Gallant
J E
JE
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000534:rehabilitation; D013997:Time Factors
D008691:Methadone