Antiretroviral Treatment Interruptions Are Common in Injection Drug Users

Interruptions of highly active antiretroviral therapy (HAART) are not recommended, and long-term interruptions can lead to HIV disease progression. Injection drug use can put people at risk for treatment interruptions. To characterize patterns of HAART use and identify characteristics associated with treatment interruptions (defined as any 6-month interval after HAART initiation in which no HAART use was reported), researchers evaluated data on 335 injection drug users from a large observational cohort who initiated HAART between 1996 and 2006 and were followed serially.

• Treatment interruptions were reported in 260 patients (78%).

• In multivariable analyses, being female, having a detectable level of HIV RNA, and reporting daily injection drug use were associated with a higher probability of having a treatment interruption.

• Treatment interruptions lasted longer in persons with higher levels of HIV RNA, in those who had been incarcerated, and in those who reported drinking alcohol.

Comments:

Interruptions in HAART treatment were common, occurred in the setting of a modifiable behavior (injection drug use), and were longer in those who reported alcohol consumption. The association between treatment interruptions and drug and alcohol use highlights the need to address substance use in HIV-infected individuals. Treatment interruptions during incarceration would likely be amendable to policy solutions. These changes could improve HAART treatment adherence. David A. Fiellin, MD

Reference:

Kavasery R, Galai N, Astemborski J, et al. Nonstructured treatment interruptions among injection drug users in Baltimore, MD. J Acquir Immune Defic Syndr. 2009; 50(4):360–366.