Illicit Drug Use, Depression, and HIV Medication Use Among Women
Illicit drug use and depressive symptoms are common in patients with HIV, may affect use of highly active antiretroviral therapy (HAART), and are both treatable. Investigators studied 1710 HIV-positive women from 6 U.S. sites to evaluate the impact of self-reported depressive symptoms and use of illicit drugs (crack, cocaine, heroin, or amphetamines) on HAART use over 8 years. Analyses controlled for potential confounding variables, including virologic and immunologic measures.
- During the 6 months before baseline, 13% of subjects used crack, 7% used heroin, 7% used cocaine, and 4% used amphetamines.
- HAART use was significantly less likely among the following:
- subjects with illicit drug use but no depressive symptoms versus those with neither (odds ratio [OR], 0.8)
- subjects with both illicit drug use and depressive symptoms versus those with neither (OR, 0.5)
- Having depressive symptoms only did not significantly affect HAART use.
Illicit drug use alone and in combination with depressive symptoms is associated with decreased use of HAART. The association between illicit drug use and HAART use has been reported previously. However, the interaction between depression and illicit drug use that further decreases the odds of HAART use is notable. These findings may reflect clinician or patient behaviors or preferences and should be confirmed in male patients. Finally, because both drug use and depression are treatable, effective interventions that address these frequently comorbid conditions should help improve use of HAART.David A. Fiellin, MD
Reference:Cook JA, Grey DD, Burke-Miller JK, et al. Illicit drug use, depression and their association with highly active antiretroviral therapy in HIV-positive women. Drug Alcohol Depend. 2007;89(1):74–81.