Elevated rates of antiretroviral treatment discontinuation among HIV-infected injection drug users: implications for drug policy and public health

Abstract

The benefits of highly active antiretroviral therapy (HAART) for the treatment of HIV disease are well documented, although concerns regarding access to and adherence to HAART among injection drug users (IDU) are of growing concern. We evaluated all antiretroviral naı̈ve HIV-infected men and women who initiated HAART between 1 August 1996 and 31 July 2000, and who were followed until 31 March 2002 in a province-wide HIV treatment programme that delivers antiretroviral therapy and AIDS care free of charge. We evaluated time to the first HAART discontinuation greater than 3 months using Kaplan–Meier methods and Cox proportional hazards regression. Overall, 1422 patients initiated HAART among whom 359 (25.3%) were IDU. At 12 months after the initiation of HAART, 30.3% of non-IDU versus 42.5% of IDU had discontinued HAART ( P<0.001). In Cox analyses, history of injection drug use was associated with more rapid discontinuation of therapy in univariate (relative hazard (RH): 1.5 (95% CI: 1.3–1.8)) and adjusted (RH: 1.4 (95% CI: 1.2–1.7)) analyses. Unless substantial changes are made to the HIV/AIDS care delivery systems, including a substantial increase in the provision of drug treatment programmes and revision of drug policies that create barriers to healthcare, in urban areas of high HIV prevalence among IDU, healthcare services for persons with HIV may soon be overwhelmed by high levels of morbidity and mortality among patients infected with HIV through injection drug use.