Abstract
ObjectiveDrug use and receipt of highly active antiretroviral therapy (HAART) were assessed in HIV-infected persons from the Comprehensive Care Center (CCC; Nashville, TN) and Johns Hopkins University HIV Clinic (JHU; Baltimore, MD) between 1999 and 2005.MethodsParticipants with and without injection drug use (IDU) history in the CCC and JHU cohorts were evaluated. Additional analysis of persons with history of IDU, non-injection drug use (NIDU), and no drug use from CCC were performed. Activity of IDU and NIDU also was assessed for the CCC cohort. HAART use and time on HAART were analyzed according to drug use category and site of care.Results1745 persons were included from CCC: 268 (15%) with IDU history and 796 (46%) with NIDU history. 1977 persons were included from JHU: 731 (35%) with IDU history. Overall, the cohorts differed in IDU risk factor rates, age, race, sex, and time in follow-up. In multivariate analyses, IDU was associated with decreased HAART receipt overall (OR = 0.61, 95% CI: [0.45–0.84] and OR = 0.58, 95% CI: [0.46–0.73], respectively for CCC and JHU) and less time on HAART at JHU (0.70, [0.55–0.88]), but not statistically associated with time on HAART at CCC (0.78, [0.56–1.09]). NIDU was independently associated with decreased HAART receipt (0.62, [0.47–0.81]) and less time on HAART (0.66, [0.52–0.85]) at CCC. These associations were not altered significantly whether patients at CCC were categorized according to historical drug use or drug use during the study period.ConclusionsPersons with IDU history from both clinic populations were less likely to receive HAART and tended to have less cumulative time on HAART. Effects of NIDU were similar to IDU at CCC. NIDU without IDU is an important contributor to HAART utilization.
Highlights
The dual global pandemics of substance abuse and HIV threaten individual and public health
Injection drug users often receive their HIV diagnosis late and may have worse clinical outcomes compared to persons without IDU [4]
This study was based on data compiled from the Comprehensive Care Center (CCC), which serves urban and rural Tennessee, and the urban Johns Hopkins University HIV Clinic (JHU) cohort in Predictors of ever receiving highly active antiretroviral therapy (HAART) (N = 1960)
Summary
The dual global pandemics of substance abuse and HIV threaten individual and public health. Injection drug use (IDU) was the HIV transmission risk factor for 35% of females and 20% of males with AIDS reported through 2007 in the United States (US) [1]. The role of IDU in HIV transmission varies according to geographic region. The distribution of AIDS cases due to IDU in 2006 was approximately 25% and 50% greater for females and males, respectively, in the Northeastern US compared with those in Southern and Midwestern states [2]. Beyond the US, IDU is fueling HIV transmission in Eastern Europe and Central, South, and South-East Asia, and is estimated to account for approximately one-third of new HIV infections outside SubSaharan Africa [3]. Injection drug users often receive their HIV diagnosis late and may have worse clinical outcomes compared to persons without IDU [4]
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