Multi-dimensional risk factor patterns associated with non-use of highly active antiretroviral therapy among human immunodeficiency virus-infected women.
OBJECTIVE
Relationships between non-use of highly active antiretroviral therapy (HAART), race/ethnicity, violence, drug use, and other risk factors are investigated using qualitative profiles of five risk factors (unprotected sex, multiple male partners, heavy drinking, crack, cocaine or heroin use, and exposure to physical violence) and association of the profiles and race/ethnicity with non-use of HAART over time.


METHODS
A hidden Markov model was used to summarize risk factor profiles and changes in profiles over time in a longitudinal sample of HIV-infected women enrolled in the Women's Interagency HIV Study with follow-up from 2002 to 2005 (n = 802).


RESULTS
Four risk factor profiles corresponding to four distinct latent states were identified from the five risk factors. Trajectory analysis indicated that states characterized by high probabilities of all risk factors or by low probabilities of all risk factors were both relatively stable over time. Being in the highest risk state did not significantly elevate the odds of HAART non-use (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.6-1.8). However, being in a latent state characterized by elevated probabilities of heavy drinking and exposure to physical violence, along with slight elevations in three other risk factors, significantly increased odds of HAART non-use (OR, 1.4; 95% CI, 1.1-1.9).


CONCLUSIONS
The research suggests that HAART use might be improved by interventions aimed at women who are heavy drinkers with recent exposure to physical violence and evidence of other risk factors. More research about the relationship between clustering and patterns of risk factors and use of HAART is needed.
Jones
Alison Snow
AS
Department of Health Management & Policy, Drexel University School of Public Health, Philadelphia, Pennsylvania 19102, USA. Alison.S.Jones@drexel.edu
Lillie-Blanton
Marsha
M
Stone
Valerie E
VE
Ip
Edward H
EH
Zhang
Qiang
Q
Wilson
Tracey E
TE
Cohen
Mardge H
MH
Golub
Elizabeth T
ET
Hessol
Nancy A
NA
D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015897:Comorbidity; D016001:Confidence Intervals; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D013287:Illicit Drugs; D008137:Longitudinal Studies; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013179:Spouse Abuse / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D016387:Women's Health; D055815:Young Adult
D019380:Anti-HIV Agents; D013287:Illicit Drugs