title: Impact of Illicit Drug Use on Health-Related Quality of Life in Opioid-Dependent Patients Undergoing HIV Treatment.
abstract: OBJECTIVE
  To assess the impact of illicit drug use on health-related quality of life (health utility) among opioid-dependent HIV-infected patients.
  
  
  METHODS
  Secondary analyses of data from the Buprenorphine-HIV Evaluation and Support cohort of HIV-infected patients with opioid dependence in 9 US HIV clinics between 2004 and 2009. Health status [short form-12 (SF-12)], combination antiretroviral treatment (ART) status, CD4 cell count, hepatitis C virus antibody status, current drug use, and demographics were assessed at the initial visit and quarterly follow-up visits until 1 year. The SF-6D health utility scores were derived from the SF-12. Multivariate mixed-effects regression models were used to assess the impact of illicit drug use on health utility controlling for demographic, clinical, and social characteristics.
  
  
  RESULTS
  Health utility was assessed among 307 participants, 67% male, with a median age of 46 years at 1089 quarterly assessments. In multivariate analyses, illicit opioid use, nonopioid illicit drug use, not being on ART, and being on ART with poor adherence were associated with lower health utility. The observed decrement in health utility associated with illicit opioid use was larger for those on ART with good adherence (beta = -0.067; P < 0.01) or poor adherence (-0.049; P < 0.01) than for those not on ART.
  
  
  CONCLUSIONS
  Illicit opioid and nonopioid drug use are negatively associated with health utility in patients with HIV; however, the relative effect of illicit opioid use is smaller than that of not being on ART. Postponing ART until initiation of opioid substitution therapy or abstinence may have limited benefits from the perspective of maximizing health utility.
authors.affiliation: Departments of *Medicine; †Healthcare Policy and Research, Weill Cornell Medical College, New York, NY; ‡British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; §Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; ‖Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA; and ¶Department of Economics, The University of North Carolina at Greensboro, Greensboro, NC.
authors.forename: Brandon
authors.initials: B
authors.lastname: Aden
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.forename: Eve
authors.initials: E
authors.lastname: Wittenberg
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Bray
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications*; D011788:Quality of Life; D019966:Substance-Related Disorders; D019562:Viral Load
chemical_list: D013287:Illicit Drugs