title: Nonadherence to antiretroviral therapy among a community with endemic rates of injection drug use.
abstract: Highly active antiretroviral therapy (HAART) has resulted in major reductions in HIV-related morbidity and mortality. However, long-term use of HAART is challenging, and substantial numbers of patients discontinue their medications prematurely. The purpose of this analysis is to describe HAART adherence rates among a large urban cohort and examine factors associated with adherence (based on refill compliance). Of the 184 eligible participants, 129 (70%) were less than 95% adherent. Variables independently associated with nonadherence included frequent heroin injection (adjusted odds ratio [AOR] = 2.6, 95% confidence interval [CI], 1.6-4.0), baseline CD4 count less than 200 cells/mm(3) (AOR = 2.5; 95% CI, 1.9-3.2), and poor treatment by health care professionals (AOR = 1.7; 95% CI, 1.2-3.0). Variables inversely associated with HAART nonadherence included attaining viral load suppression (AOR = 0.3; 95% CI, 0.2-0.5) and methadone maintenance therapy (AOR = 0.5; 95% CI, 0.4-0.9). Innovative strategies that address the social barriers facing marginalized populations are needed to support the long-term continuation of HAART.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Calvin
authors.initials: C
authors.lastname: Lai
authors.forename: Tomiye
authors.initials: T
authors.lastname: Ishida
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D010349:Patient Compliance; D015819:Substance Abuse, Intravenous; D019562:Viral Load