Nonadherence to antiretroviral therapy among a community with endemic rates of injection drug use.
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.
Shannon
Kate
K
British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Canada.
Kerr
Thomas
T
Lai
Calvin
C
Ishida
Tomiye
T
Wood
Evan
E
Montaner
Julio S G
JS
Hogg
Robert S
RS
Tyndall
Mark W
MW
D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D010349:Patient Compliance; D015819:Substance Abuse, Intravenous; D019562:Viral Load