title: Drug use and receipt of highly active antiretroviral therapy among HIV-infected persons in two U.S. clinic cohorts.
abstract: OBJECTIVE
  Drug use and receipt of highly active antiretroviral therapy (HAART) were assessed in HIV-infected persons from the Comprehensive Care Center (CCC; Nashville, TN) and Johns Hopkins University HIV Clinic (JHU; Baltimore, MD) between 1999 and 2005.
  
  
  METHODS
  Participants with and without injection drug use (IDU) history in the CCC and JHU cohorts were evaluated. Additional analysis of persons with history of IDU, non-injection drug use (NIDU), and no drug use from CCC were performed. Activity of IDU and NIDU also was assessed for the CCC cohort. HAART use and time on HAART were analyzed according to drug use category and site of care.
  
  
  RESULTS
  1745 persons were included from CCC: 268 (15%) with IDU history and 796 (46%) with NIDU history. 1977 persons were included from JHU: 731 (35%) with IDU history. Overall, the cohorts differed in IDU risk factor rates, age, race, sex, and time in follow-up. In multivariate analyses, IDU was associated with decreased HAART receipt overall (OR = 0.61, 95% CI: [0.45-0.84] and OR = 0.58, 95% CI: [0.46-0.73], respectively for CCC and JHU) and less time on HAART at JHU (0.70, [0.55-0.88]), but not statistically associated with time on HAART at CCC (0.78, [0.56-1.09]). NIDU was independently associated with decreased HAART receipt (0.62, [0.47-0.81]) and less time on HAART (0.66, [0.52-0.85]) at CCC. These associations were not altered significantly whether patients at CCC were categorized according to historical drug use or drug use during the study period.
  
  
  CONCLUSIONS
  Persons with IDU history from both clinic populations were less likely to receive HAART and tended to have less cumulative time on HAART. Effects of NIDU were similar to IDU at CCC. NIDU without IDU is an important contributor to HAART utilization.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America. c.mcgowan@Vanderbilt.Edu
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.forename: David D
authors.initials: DD
authors.lastname: Weinstein
authors.forename: Charles P
authors.initials: CP
authors.lastname: Samenow
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Stinnette
authors.forename: Gema
authors.initials: G
authors.lastname: Barkanic
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Todd
authors.initials: T
authors.lastname: Hulgan
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015142:Baltimore; D015331:Cohort Studies; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013714:Tennessee; D013997:Time Factors; D014481:United States