Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection

Objective: To identify the effects of substance abuse status (active. forme r, and never) on utilization of highly active antiretroviral therapy (HAART ), medication adherence, and virologic and immunologic responses to therapy . Design: Prospective cohort study of 764 HIV-1-infected patients who attende d an urban HIV clinic and participated in a standardized interview. Main Outcome Measures: Past utilization of HAART, self-reported nonadherenc e with antiretroviral therapy, and changes in HIV-1 RNA level and CD4(+) ly mphocyte count relative to prior peak and nadir, respectively. Results: Forty-four percent of active drug users failed to utilize HAART co mpared with 22% of former drug users and 18% of non-drug users (p < .001 fo r both comparisons). Among participants: who were taking antiretroviral the rapy when interviewed, active drug users were more likely to report medicat ion nonadherence (34% vs. 24% of nonusers and 17% of former users), had a s maller median reduction in HIV-I RNA from baseline (0.8 log(10) copies/ml v s. 1.7 in nonusers and 1.6 in former users), and had smaller median increas es in CD4(+) lymphocyte count from baseline (65 cells/mm(3) vs. 116 in nonu sers and 122 in former users) (p < .05 for all comparisons with active user s). Conclusions: Active drug use was strongly associated with underutilization of HAART, nonadherence, and inferior virologic and immunologic responses to therapy, whereas former drug users and non-drug users were similar in all outcomes. Effective strategies Lire needed that integrate HIV-I and substan ce abuse treatments.