Time to initiating highly active antiretroviral therapy among HIV infectedinjection drug users

Objective: Studies have shown that HIV-infected injection drug users (IDUs) are less likely to receive antiretroviral therapy than non-drug users. We assess factors associated with initiating highly active antiretroviral ther apy (HAART) in HIV-infected IDUs. Methods: A cohort study of IDUs carried out between 1 January 1996 and 30 J une 1999 at a community-based study clinic affiliated to the Johns Hopkins University, Baltimore, Maryland. The participants were a total of 528 HIV-i nfected IDUs eligible for HAART based on CD4+ cell count. The main outcome measure was the time from treatment eligibility to first self-reported HAAR T use, as defined by the International AIDS Society-USA panel (IAS-USA) gui delines. Results: By 30 June 1999, 58.5% of participants had initiated HAART, most o f whom switched from mono- or dual-combination therapy to a HAART regimen. Nearly one-third of treatment-eligible IDUs never received antiretroviral t herapy. Cox proportional hazards regression showed that initiating HAART wa s independently associated with not injecting drugs, methadone treatment am ong men, having health insurance and a regular source of care, lower CD4+ c ell count and a history of antiretroviral therapy. Conclusions: Self-reported initiation of HAART is steadily increasing among IDUs who are eligible for treatment; however, a large proportion continues to use non-HAART regimens and many remain treatment-naive. Although both g roups appear to have lower health care access and utilization, IDUs without a history of antiretroviral therapy use would have more treatment options available to them once they become engaged in HIV care. (C) 2001 Lippincott Williams & Wilkins.