title: Nonadherence among HIV-infected injecting drug users: the impact of social instability.
abstract: The authors tested the impact of social instability on adherence to highly active antiretroviral therapy (HAART) among patients infected with HIV through injection drug use (IDU; MANIF2000 cohort). In the study, they analyzed sociodemographic baseline characteristics to develop an indicator of social instability. Information concerning adherence to HAART was collected through questionnaires during a 2-year follow-up period. Factors associated with nonadherence were studied in two different groups: 1) patients who had stopped injection drug use (ex-IDUs) and who were not in drug maintenance programs (DMT) during the entire follow-up period, and 2) those who were still opiate dependent. Among the 210 eligible patients, 114 were classified as ex-IDUs and 96 as opiate dependent. Ex-IDUs reported nonadherence behaviors in 96 of 384 visits (25.0%), while opiate-dependent patients were nonadherent in 111 of 308 visits (36.0%; p = .02). Among ex-IDUs, the only factor associated with nonadherence was social instability, while among opiate-dependent patients, injection behavior was the only determinant of nonadherence behavior. For opiate-dependent patients, DMT may enhance adherence to HAART, but only if it is successful in reducing abuse of injection practices. For ex-IDUs, it is very important that the management of social difficulties be taken into account to increase adherence to HAART.
authors.affiliation: Regional Center for Disease Control of Southeastern France (ORS PACA), Marseilles, France.
authors.forename: Anne-Déborah
authors.initials: AD
authors.lastname: Bouhnik
authors.forename: Margaret
authors.initials: M
authors.lastname: Chesney
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carrieri
authors.forename: Hervé
authors.initials: H
authors.lastname: Gallais
authors.forename: Jacques
authors.initials: J
authors.lastname: Moreau
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: Yolande
authors.initials: Y
authors.lastname: Obadia
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D003863:Depression / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000523:psychology; D010349:Patient Compliance; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*