title: Poor adherence to HIV monitoring and treatment guidelines for HIV-infected injection drug users.
abstract: OBJECTIVE
  There is growing concern about access to HIV/AIDS care among injection drug users (IDUs). We examined rates of CD4 cell count monitoring and correlates among HIV-infected IDUs.
  
  
  METHODS
  This prospective observational cohort study of 460 community-recruited HIV-infected IDUs was situated in a Canadian city where all medical care is provided free of charge. Over a median follow-up period of 76 months, we evaluated factors associated with CD4 cell count monitoring through a linkage with a centralized CD4 registry.
  
  
  RESULTS
  Overall, <5% of IDUs had CD4 monitoring consistent with local therapeutic guidelines. In multivariate analyses, after adjustment for being on antiretroviral therapy [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.84-2.70, P<0.001] female gender (OR 0.71, 95% CI 0.57-0.89, P=0.003), non-White ethnicity (OR 0.75, 95% CI 0.60-0.94, P=0.014), use of methadone maintenance therapy (OR 1.66, 95% CI 1.42-1.94, P<0.001) and daily heroin use (OR 0.72, 95% CI 0.61-0.85, P<0.001) were independently associated with CD4 monitoring.
  
  
  CONCLUSIONS
  Strategies to improve CD4 surveillance among IDUs are critically important, particularly for female and non-White IDUs. Expanded treatment for heroin dependence appears to have the greatest potential for improved care.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada. uhri@cfenet.ubc.ca
authors.forename: E
authors.initials: E
authors.lastname: Wood
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.forename: R
authors.initials: R
authors.lastname: Zhang
authors.forename: S
authors.initials: S
authors.lastname: Guillemi
authors.forename: A
authors.initials: A
authors.lastname: Palepu
authors.forename: R S
authors.initials: RS
authors.lastname: Hogg
authors.forename: J S G
authors.initials: JS
authors.lastname: Montaner
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002170:Canada; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D008691:Methadone