Impact of Substance Use on Adherence to HIV Medications

High levels of adherence to highly active antiretroviral therapy (HAART) are associated with improved outcomes for patients with HIV. Through interviews with 659 patients with HIV, researchers in this study assessed whether illicit substance use and receiving substance use treatment influence adherence to HAART.

• Forty-two percent of the patients had used illicit drugs in the past 6 months (current use); 30% had used illicit drugs but not in the past 6 months (former use), and 28% had never used illicit drugs.

• Adherence was
  • significantly less common among subjects with current use (60%) than among subjects with former (68%) or no (77%) use;
  • similar between subjects with former use who had received recent substance use treatment and subjects with no use;
  • lower in subjects with former use who had not received recent substance use treatment than in subjects with no use (adjusted odds ratio, 0.6; P=0.05);
  • lower in subjects with current use than in subjects with no use, regardless of receipt of substance use treatment.

Comments:

This study demonstrates the potential adverse impact of illicit drug use on adherence to HIV medications. It also indicates the importance of ongoing substance use treatment for people with past substance use. The study is limited because it did not evaluate biologic outcomes (e.g., CD4 cell count or HIV viral load) or the impact of alcohol separately from the impact of illicit substance use in multivariate analyses. Nonetheless, these findings support the importance of engaging patients with HIV and substance use (current or former) in substance use treatment.

David A. Fiellin, MD

Reference:

Hicks PL, Mulvey KP, Chander G, et al. The impact of illicit drug use and substance abuse treatment on adherence to HAART. AIDS Care. 2007;19(9):1134–1140.