title: Improved adherence to modern antiretroviral therapy among HIV-infected injecting drug users.
abstract: OBJECTIVE
  Adherence to antiretroviral therapy (ART) among injecting drug users (IDUs) is often suboptimal, yet little is known about changes in patterns of adherence since the advent of highly active antiretroviral therapy in 1996. We sought to assess levels of optimal adherence to ART among IDUs in a setting of free and universal HIV care.
  
  
  METHODS
  Data were collected through a prospective cohort study of HIV-positive IDUs in Vancouver, British Columbia. We calculated the proportion of individuals achieving at least 95% adherence in the year following initiation of ART from 1996 to 2009.
  
  
  RESULTS
  Among 682 individuals who initiated ART, the median age was 37 years (interquartile range 31-44 years) and 248 participants (36.4%) were female. The proportion achieving at least 95% adherence increased over time, from 19.3% in 1996 to 65.9% in 2009 (Cochrane-Armitage test for trend: P < 0.001). In a logistic regression model examining factors associated with 95% adherence, initiation year was statistically significant (odds ratio 1.08; 95% confidence interval 1.03-1.13; P < 0.001 per year after 1996) after adjustment for a range of drug use variables and other potential confounders.
  
  
  CONCLUSIONS
  The proportion of IDUs achieving at least 95% adherence during the first year of ART has consistently increased over a 13-year period. Although improved tolerability and convenience of modern ART regimens probably explain these positive trends, by the end of the study period a substantial proportion of IDUs still had suboptimal adherence, demonstrating the need for additional adherence support strategies.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Mann
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.forename: R
authors.initials: R
authors.lastname: Zhang
authors.forename: J
authors.initials: J
authors.lastname: Montaner
authors.forename: E
authors.initials: E
authors.lastname: Wood
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012367:RNA, Viral; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral