title: Effectiveness of antiretroviral therapy in HIV-1-infected active drug users attended in a drug abuse outpatient treatment facility providing a multidisciplinary care strategy.
abstract: OBJECTIVE
  HIV-1-infected active drug users (ADU) obtain smaller clinical benefits with antiretroviral therapy (HAART) compared to non-ADU subjects with sexually-transmitted HIV-1 infection. Therefore treatment strategies are required to address the specific issues arising in this challenging scenario. We describe the effectiveness of HAART provided in a drug abuse outpatient treatment facility through a comprehensive integrated care that includes medical, drug dependence, and psychosocial support.
  
  
  METHODS
  We included all consecutive HIV-1-infected ADU admitted for drug dependency treatment and who started their first HAART. A comparator arm consisted of a control group of sexually transmitted HIV-1-infected subjects attended in a reference hospital under standard care. The strategy did not include directly observed treatment.
  
  
  RESULTS
  A total of 71 ADU and 48 matched subjects infected through sexual transmission were included. ADU had lower baseline CD4+ T-cell counts (196 vs 279 cells/μL, P=.001), and more advanced CDC stages (P=.001). The estimated probabilities of patients with virological response ( < 50 copies/mL) at weeks 48 and 96 were 92.9% (95%-CI: 87.1%-99.1%) and 87.3% (95%-CI: 78.7%-95.2% for ADU, and 93.7%(95%-CI: 84.1%-99.8%) and 87.5% (95%-CI: 77.5%-97.3%) for sexually-infected subjects (P= .1325 and .241). Kaplan-Meier estimates of time to loss of virological response did not show differences between groups (log rank test, P=.965).
  
  
  CONCLUSIONS
  An integrated multidisciplinary care of HIV-1-infected antiretroviral naïve ADU provided in a drug abuse treatment center obtains high rates of virological suppression, similar to those observed in a comparison group of sexually-transmitted HIV-1-infected subjects. This strategy should be further evaluated in public health programs and assessed in randomized trials.
authors.affiliation: Department of Internal Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain. 91773@parcdesalutmar.cat
authors.forename: Gabriel V
authors.initials: GV
authors.lastname: Sánchez
authors.forename: Josep M
authors.initials: JM
authors.lastname: Llibre
authors.forename: Marta
authors.initials: M
authors.lastname: Torrens
authors.forename: Arantza
authors.initials: A
authors.lastname: Sanvisens
authors.forename: Gerard
authors.initials: G
authors.lastname: Mateu
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.forename: Klaus
authors.initials: K
authors.lastname: Langohr
authors.forename: Jose R
authors.initials: JR
authors.lastname: Santos
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000276:immunology*; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D010349:Patient Compliance; D018579:Patient Selection; D012367:RNA, Viral / Q000097:blood; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D011795:Surveys and Questionnaires
chemical_list: D012367:RNA, Viral; D008691:Methadone