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Adherence to antiretroviral treatment (ART) of HIV-infected persons with or without injection drug use (IDU) or in a drug addiction treatment program: the Swiss HIV cohort study
M. Huber1, B. Ledergerber1, H. Furrer2, L. Elzi3, B. Hirschel4, M. Cavassini5, P. Vernazza6, E. Bernasconi7, M. Rickenbach8, R. Weber1, Swiss HIV Cohort Study
1University Hospital, Division of Infectious Diseases, Zurich, Switzerland, 2University Hospital, Division of Infectious Diseases, Bern, Switzerland, 3University Hospital, Division of Infectious Diseases, Basel, Switzerland, 4University Hospital, Division of Infectious Diseases, Geneva, Switzerland, 5University Hospital, Division of Infectious Diseases, Lausanne, Switzerland, 6Cantonal Hospital, Division of Infectious Diseases, St.Gallen, Switzerland, 7Ospedale Civico, Division of Infectious Diseases, Lugano, Switzerland, 8Swiss HIV Cohort Study, Data Center, Lausanne, Switzerland
Background: The term IDU is often used to describe the HIV transmission category. However, current illegal drug use behaviour is not reflected with this term. We classified IDU into:
(i) former;
(ii) DTP (drug treatment program);
(iii) DTP with ongoing; or
(iv) current drug use without DTP. We analyzed predictors for being on ART and virological outcome, and studied the relationship between illegal drug use and self-reported adherence.
Methods: All participants of the Swiss HIV Cohort Study (SHCS) between 1997 and 2006 were analysed. Cofactors of outcome were investigated using robust multivariable logistic regression.
Results: A total of 8,660 HIV-infected persons were analysed: 6091 never IDU at baseline, 1080 former, 741 DTP, 607 DTP with ongoing, and 141 with current injection drug use without DTP. The table shows odds ratios (adjusted for calendar year, sex, age, AIDS, CD4) of being on ART, interrupting ART, and having a viral load below limit of detection. Self reported adherence within the previous month was in non-IDU 78.7%; former IDU 69.8%; DTP 70.9 %; DTP with ongoing injection behaviour 60.6%; current injection drug users 54.9%.
| | Being on ART | Suppressed viral replication on ART | Interrupted ART | | Non-IDU | 1 | 1 | 1 | | Former | 1.19 (1.06-1.32) | 0.96 (0.87-1.07) | 1.00 (0.88-1.14) | | DTP only | 1.08 (0.95-1.22) | 0.94 (0.84-1.06) | 0.98 (0.85-1.14) | | DTP with IDU | 0.53 (0.47-0.61) | 0.79 (0.67-0.92) | 1.85 (1.58-2.17) | | Current IDU | 0.44 (0.34-0.57) | 0.67 (0.52-0.87) | 2.01 (1.49-2.73) |
Conclusions: The likelihood of being on ART and virological outcome were comparable between never- and former-IDU. In contrast, the results differed between the different IDU categories. Former IDU and persons in a DTP were more likely on ART and had an improved virological outcome compared with persons currently injecting drugs with or without DTP. Self reported adherence correlated with drug use behaviour.
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