title: Use of highly active antiretroviral therapy is increasing in HIV positive severe drug users.
abstract: BACKGROUND
  Substance abuse greatly impacts the effectiveness of highly active antiretroviral therapy (HAART). We analyzed antiretroviral use in drug users positive for human immunodeficiency virus (HIV) that sought substance abuse treatment.
  
  
  METHODS
  This cross-sectional study recruited 705 patients HIV positive (74.6% men) between 1997 and 2007. Patients were grouped by calendar periods when different HAART regimens were available in Spain (p1: 1997-1999, n=299; p2: 2000-2003, n=249; and p3: 2004-2007, n=157).
  
  
  RESULTS
  The mean age at admission was 34 years; 94.7% had a past history of injection drug use (IDU) and 67.7% were current IDUs. The average CD4 cell count was 399 cells/µL [interquartile range:203-632 cells/µL]. Lifetime prevalence of antiretroviral use was 59.4% (416/705; p1: 48.1%; p2: 64.6%; p3: 72.6%; p<0.05). The overall prevalence of antiretroviral use at admission was 40.7% (p1: 31.4%; p2: 41.0%; p3: 58.0%; p<0.05). In multivariate logistic regression analysis, age, calendar period, and non-IDU were predictors of antiretroviral use at admission. Among those taking antiretrovirals, 21.6% were on suboptimal HAART, mostly in the p1 group. Overall, 44.6% of patients were taking protease inhibitor and non-nucleoside reverse transcriptase inhibitor (PI-NNRTI), 21.9% were taking NRTI-NNRTI, and 9.4% were taking three NRTIs. Although not significant, the three-NRTI regimen was associated with CD4 >350 cells/µL and HIV RNA <400 copies/mL.
  
  
  CONCLUSIONS
  HAART use is steadily increasing in HIV positive heavy drug users. However, part of this population remains antiretroviral therapy-naïve despite advanced immunodeficiency. Interventions that focus on integrating substance abuse with HIV/AIDS treatments are needed.
authors.affiliation: Department of Psychiatry, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Vallecillo
authors.forename: A
authors.initials: A
authors.lastname: Sanvisens
authors.forename: E
authors.initials: E
authors.lastname: Martinez
authors.forename: M
authors.initials: M
authors.lastname: Torrens
authors.forename: F
authors.initials: F
authors.lastname: Bolao
authors.forename: J
authors.initials: J
authors.lastname: Tor
authors.forename: R
authors.initials: R
authors.lastname: Muga
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data* / Q000639:trends; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D013030:Spain; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents