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Nonadherence to Antiretroviral Therapy Among a Community With Endemic Rates of Injection Drug Use

British Columbia Centre for Excellence in HIV/AIDS

Thomas Kerr, PhD

British Columbia Centre for Excellence in HIV/AIDS

Calvin Lai, MMath

British Columbia Centre for Excellence in HIV/AIDS

Tomiye Ishida

British Columbia Centre for Excellence in HIV/AIDS

Evan Wood, PhD

British Columbia Centre for Excellence in HIV/AIDS, Department of Health Care and Epidemiology at the University of British Columbia, Canada

Julio S. G. Montaner, MD

British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine at the University of British Columbia, Canada

Robert S. Hogg, PhD

British Columbia Centre for Excellence in HIV/AIDS, Department of Health Care and Epidemiology at the University of British Columbia, Canada

Mark W. Tyndall, ScD, MD

British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine at the University of British Columbia, Canada, mtyndall{at}cfenet.ubc.ca

Highly active antiretroviral therapy (HAART) has resulted in major reductions in HIV-related morbidity and mortality. However, long-term use of HAART is challenging, and substantial numbers of patients discontinue their medications prematurely. The purpose of this analysis is to describe HAART adherence rates among a large urban cohort and examine factors associated with adherence (based on refill compliance). Of the 184 eligible participants, 129 (70%) were less than 95% adherent. Variables independently associated with nonadherence included frequent heroin injection (adjusted odds ratio [AOR] = 2.6, 95% confidence interval [CI], 1.6-4.0), baseline CD4 count less than 200 cells/mm³ (AOR = 2.5; 95% CI, 1.9-3.2), and poor treatment by health care professionals (AOR = 1.7; 95% CI, 1.2-3.0). Variables inversely associated with HAART nonadherence included attaining viral load suppression (AOR = 0.3; 95% CI, 0.2-0.5) and methadone maintenance therapy (AOR = 0.5; 95% CI, 0.4-0.9). Innovative strategies that address the social barriers facing marginalized populations are needed to support the long-term continuation of HAART.

Key Words: highly active antiretroviral therapy (HAART) • nonadherence • injection drug use

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 4, No. 3, 66-72 (2005)
DOI: 10.1177/1545109705284353


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