title: Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection.
abstract: OBJECTIVE
  Mental health and substance use problems are common among patients infected with human immunodeficiency virus (HIV) and may impede adherence to antiretroviral regimens. This study investigated associations of antiretroviral medication nonadherence with specific types of psychiatric disorders and drug use, and varying levels of alcohol use.
  
  
  METHODS
  Data were drawn from a survey of a national probability sample of 2267 (representing 181,557) adults enrolled in the HIV Cost and Services Utilization Study. This study focused on 1910 patients who reported their antiretroviral medication adherence during the past week.
  
  
  RESULTS
  Patients with depression (odds ratio [OR] = 1.7; 95% confidence interval [CI]: 1.3 to 2.3), generalized anxiety disorder (OR = 2.4; 95% CI: 1.2 to 5.0), or panic disorder (OR = 2.0; 95% CI: 1.4 to 3.0) were more likely to be nonadherent than those without a psychiatric disorder. Nonadherence was also associated with use of cocaine (OR = 2.2; 95% CI: 1.2 to 3.8), marijuana (OR = 1.7; 95% CI: 1.2 to 2.3), amphetamines (OR = 2.3; 95% CI: 1.2 to 4.2), or sedatives (OR = 1.6; 95% CI: 1.0 to 2.4) in the previous month. Compared with patients who did not drink, those who were moderate (OR = 1.6; 95% CI: 1.3 to 2.0), heavy (OR = 1.7; 95% CI: 1.3 to 2.3), or frequent heavy (OR = 2.7; 95% CI: 1.7 to 4.5) drinkers were more likely to be nonadherent. These associations could not be explained by demographic, clinical, and treatment factors.
  
  
  CONCLUSIONS
  These findings suggest the need for screening and treatment for mental health and substance use problems among HIV-positive patients to improve adherence to antiretroviral medications.
authors.affiliation: RAND Health, Santa Monica, California 90407-2138, USA. joan_tucker@rand.org
authors.forename: Joan S
authors.initials: JS
authors.lastname: Tucker
authors.forename: M Audrey
authors.initials: MA
authors.lastname: Burnam
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.forename: Fuan-Yue
authors.initials: FY
authors.lastname: Kung
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications*; D016312:Treatment Refusal / Q000706:statistics & numerical data*