AEGiS-15IAC: Factors associated with discontinuation of highly active antiretroviral therapy among injection drug users.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Factors associated with discontinuation of highly active antiretroviral therapy among injection drug users.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrC1321)

Sethi AK, Celentano DD, Gallant JE, Vlahov D
Case Western Reserve University School of Medicine, Cleveland, United States

BACKGROUND: Previously, we showed that HIV-infected injection drug users (IDUs) in Baltimore, Maryland, USA, who were actively using experienced delays in initiating highly active antiretroviral therapy (HAART) despite being indicated for treatment. In the present study, we examine factors associated with the discontinuation of HAART among IDUs who initiated HAART.

METHODS: This study was done in the AIDS Links to Intravenous Experience (ALIVE) cohort of IDUs in Baltimore, Maryland, USA. We identified IDUs who reported first HAART use between December 1996 and June 2003. Using Kaplan-Meier and Cox proportional hazards regression, we determined factors associated with the time from starting HAART to discontinuation. We hypothesized that active injection and relapse (defined as injection of drugs in the previous 6 months) was associated with greater discontinuation of HAART.

RESULTS: During the study period, 328 IDUs initiated HAART, among whom 154 (47%) were active injectors and 174 (53%) were not. Overall, 106 (69%) active and 125 (72%) non-active injection drug users discontinued HAART (p=0.863). Recent injection [Relative hazard (RH)=1.03, 95% CI: 0.79-1.34, p=0.810) nor daily injection (vs. non-injection, RH=1.06, 95% CI: 0.72-1.57, p=0.755) were associated with HAART discontinuation. However, receiving a HAART regimen that contained a protease inhibitor (PI) was associated with greater discontinuation (RH=1.35, 95% CI: 1.00-1.82, p=0.049) and remained significant after adjusting for baseline CD4 cell count, recent injection, and always seeing the same clinician for HIV care (RH=1.46, 95% CI: 1.07-2.00, p=0.019).

CONCLUSIONS: IDUs who are actively injecting or relapse into drug use are not more likely to discontinue HAART as compared to former IDUs. Receiving a HAART regimen containing a PI was drug users were not more likely to discontinue HAART; however, being prescribed a PI was independently associated HAART discontinuation among IDUs.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Substance Abuse, Intravenous, HIV Seropositivity, Substance-Related Disorders, Acquired Immunodeficiency Syndrome, Baltimore, Maryland

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