Open AccessEffects of Drug Abuse and Mental Disorders on Use and Type of Antiretroviral Therapy in HIV‐infected Persons
Author(s) -
Turner Barbara J.,
Fleishman John A.,
Wenger Neil,
London Andrew S.,
Burnam M. Audrey,
Shapiro Martin F.,
Bing Eric G.,
Stein Michael D.,
Longshore Douglas,
Bozzette Samuel A.
Publication year - 2001
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1046/j.1525-1497.2001.016009625.x
Subject(s) - medicine , substance abuse , psychiatry , population , mental health , odds ratio , alcohol abuse , drug , environmental health
OBJECTIVE: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use. DESIGN: Prospective population‐based probability sample of 2,267 (representing 213,308) HIV‐infected persons in care in the United States in early 1996. MEASUREMENTS: Self‐reported ART from first (January 1997–July 1997) to second (August 1997–January 1998) follow‐up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first follow‐up interview. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART. RESULTS Of our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR, 0.74; CI, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97), severe drug abuse (AOR, 0.52; CI, 0.32 to 0.87), and HIV risk from injection drug use (AOR, 0.55; CI, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART (AOR, 1.57; CI, 1.11 to 2.08). CONCLUSIONS: Drug abuse‐related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy.