OBJECTIVES: Adherence to antiretroviral therapy (ART) among injecting drug users (IDUs) is often suboptimal, yet little is known about changes in patterns of adherence since the advent of highly active antiretroviral therapy in 1996. We sought to assess levels of optimal adherence to ART among IDUs in a setting of free and universal HIV care. METHODS: Data were collected through a prospective cohort study of HIV-positive IDUs in Vancouver, British Columbia. We calculated the proportion of individuals achieving at least 95% adherence in the year following initiation of ART from 1996 to 2009. RESULTS: Among 682 individuals who initiated ART, the median age was 37 years (interquartile range 31-44 years) and 248 participants (36.4%) were female. The proportion achieving at least 95% adherence increased over time, from 19.3% in 1996 to 65.9% in 2009 (Cochrane-Armitage test for trend: P < 0.001). In a logistic regression model examining factors associated with 95% adherence, initiation year was statistically significant (odds ratio 1.08; 95% confidence interval 1.03-1.13; P < 0.001 per year after 1996) after adjustment for a range of drug use variables and other potential confounders. CONCLUSIONS: The proportion of IDUs achieving at least 95% adherence during the first year of ART has consistently increased over a 13-year period. Although improved tolerability and convenience of modern ART regimens probably explain these positive trends, by the end of the study period a substantial proportion of IDUs still had suboptimal adherence, demonstrating the need for additional adherence support strategies.
OBJECTIVES: Adherence to antiretroviral therapy (ART) among injecting drug users (IDUs) is often suboptimal, yet little is known about changes in patterns of adherence since the advent of highly active antiretroviral therapy in 1996. We sought to assess levels of optimal adherence to ART among IDUs in a setting of free and universal HIV care. METHODS: Data were collected through a prospective cohort study of HIV-positive IDUs in Vancouver, British Columbia. We calculated the proportion of individuals achieving at least 95% adherence in the year following initiation of ART from 1996 to 2009. RESULTS: Among 682 individuals who initiated ART, the median age was 37 years (interquartile range 31-44 years) and 248 participants (36.4%) were female. The proportion achieving at least 95% adherence increased over time, from 19.3% in 1996 to 65.9% in 2009 (Cochrane-Armitage test for trend: P < 0.001). In a logistic regression model examining factors associated with 95% adherence, initiation year was statistically significant (odds ratio 1.08; 95% confidence interval 1.03-1.13; P < 0.001 per year after 1996) after adjustment for a range of drug use variables and other potential confounders. CONCLUSIONS: The proportion of IDUs achieving at least 95% adherence during the first year of ART has consistently increased over a 13-year period. Although improved tolerability and convenience of modern ART regimens probably explain these positive trends, by the end of the study period a substantial proportion of IDUs still had suboptimal adherence, demonstrating the need for additional adherence support strategies.
Authors: Julia H Arnsten; Xuan Li; Yuko Mizuno; Amy R Knowlton; Marc N Gourevitch; Kathleen Handley; Kelly R Knight; Lisa R Metsch Journal: J Acquir Immune Defic Syndr Date: 2007-11-01 Impact factor: 3.731
Authors: M J Milloy; Thomas Kerr; Jane Buxton; Tim Rhodes; Silvia Guillemi; Robert Hogg; Julio Montaner; Evan Wood Journal: J Infect Dis Date: 2011-05-01 Impact factor: 5.226
Authors: S M Hammer; K E Squires; M D Hughes; J M Grimes; L M Demeter; J S Currier; J J Eron; J E Feinberg; H H Balfour; L R Deyton; J A Chodakewitz; M A Fischl Journal: N Engl J Med Date: 1997-09-11 Impact factor: 91.245
Authors: S M Hammer; D A Katzenstein; M D Hughes; H Gundacker; R T Schooley; R H Haubrich; W K Henry; M M Lederman; J P Phair; M Niu; M S Hirsch; T C Merigan Journal: N Engl J Med Date: 1996-10-10 Impact factor: 91.245
Authors: Thomas Kerr; Anita Palepu; Gordon Barness; John Walsh; Robert Hogg; Julio Montaner; Mark Tyndall; Evan Wood Journal: Antivir Ther Date: 2004-06
Authors: Evan Wood; Robert S Hogg; Benita Yip; P Richard Harrigan; Michael V O'Shaughnessy; Julio S G Montaner Journal: Ann Intern Med Date: 2003-11-18 Impact factor: 25.391
Authors: Nancy A Hessol; Susan Holman; Howard Minkoff; Mardge H Cohen; Elizabeth T Golub; Seble Kassaye; Roksana Karim; Oluwakemi Sosanya; Christopher Shaheen; Zaher Merhi Journal: AIDS Care Date: 2015-08-14
Authors: Seonaid Nolan; Alexander Y Walley; Timothy C Heeren; Gregory J Patts; Alicia S Ventura; Meg M Sullivan; Jeffrey H Samet; Richard Saitz Journal: AIDS Care Date: 2017-05-17
Authors: David B Hanna; Kate Buchacz; Kelly A Gebo; Nancy A Hessol; Michael A Horberg; Lisa P Jacobson; Gregory D Kirk; Mari M Kitahata; P Todd Korthuis; Richard D Moore; Sonia Napravnik; Pragna Patel; Michael J Silverberg; Timothy R Sterling; James H Willig; Bryan Lau; Keri N Althoff; Heidi M Crane; Ann C Collier; Hasina Samji; Jennifer E Thorne; M John Gill; Marina B Klein; Jeffrey N Martin; Benigno Rodriguez; Sean B Rourke; Stephen J Gange Journal: Clin Infect Dis Date: 2013-01-11 Impact factor: 9.079
Authors: Ryan McNeil; Laura B Dilley; Manal Guirguis-Younger; Stephen W Hwang; Will Small Journal: J Int AIDS Soc Date: 2014-03-13 Impact factor: 5.396
Authors: Nikoloz Chkhartishvili; Nino Rukhadze; Mariam Svanidze; Lali Sharvadze; Jack A Dehovitz; Tengiz Tsertsvadze; Louise-Anne McNutt; Carlos del Rio Journal: J Int AIDS Soc Date: 2014-04-09 Impact factor: 5.396
Authors: Awachana Jiamsakul; Nagalingeswaran Kumarasamy; Rossana Ditangco; Patrick C K Li; Praphan Phanuphak; Thira Sirisanthana; Somnuek Sungkanuparph; Pacharee Kantipong; Christopher K C Lee; Mahiran Mustafa; Tuti Merati; Adeeba Kamarulzaman; Thida Singtoroj; Matthew Law Journal: J Int AIDS Soc Date: 2014-05-16 Impact factor: 5.396