title: Factors associated with nonadherence to antiretroviral therapy in HIV-positive smokers.
abstract: Adherence to antiretroviral therapy (ART) has markedly improved HIV disease management, and significantly reduced HIV/AIDS-associated morbidity and mortality. Although recent studies suggest a relationship between smoking and suboptimal adherence to ART, a more in-depth understanding of this relationship is needed. We conducted a secondary analysis using data from a randomized controlled smoking cessation trial to investigate the association of nonadherence to ART with potential demographic, psychosocial (perceived stress and depression), and substance use (nicotine dependence, illicit drug use, and alcohol use) variables among persons living with HIV/AIDS (PLWHA) who smoke. The mean (standard deviation [SD]) age of participants (n=326) was 45.9 years old (SD=7.6). Additionally, the majority were male (72.1%), self-identified as black (76.7%), and reported sexual contact as the mode of HIV acquisition (70%). Unadjusted logistic regression analysis indicated that depression (odds ratio [OR]=1.02; 95% confidence interval [CI]=1.00, 1.04), illicit drug use (OR=2.39; 95% CI=1.51, 3.79) and alcohol use (OR=2.86; 95%CI=1.79, 4.57) were associated with nonadherence. Adjusted logistic regression analysis indicated that nicotine dependence (OR=1.13; 95% CI=1.02, 1.25), illicit drug use (OR=2.10; 95% CI=1.27, 3.49), alcohol use (OR=2.50; 95% CI=1.52, 4.12), and age (OR=1.04; 95% CI=1.00, 1.07) were associated with nonadherence. Nicotine dependence, illicit drug use, and alcohol use are potentially formidable barriers to ART adherence among PLWHA who smoke. Future efforts should investigate the complex relationships among these variables to improve adherence particularly among populations confronted with multifaceted health challenges.
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. rmmarks@mdanderson.org
authors.forename: Rachel Marks
authors.initials: RM
authors.lastname: King
authors.forename: Damon J
authors.initials: DJ
authors.lastname: Vidrine
authors.forename: Heather E
authors.initials: HE
authors.lastname: Danysh
authors.forename: Faith E
authors.initials: FE
authors.lastname: Fletcher
authors.forename: Sheryl
authors.initials: S
authors.lastname: McCurdy
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Arduino
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Gritz
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001294:Attitude to Health; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D012944:Social Support; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents