Poor adherence to HIV monitoring and treatment guidelines for HIV-infected injection drug users

HIV Med. 2008 Aug;9(7):503-7. doi: 10.1111/j.1468-1293.2008.00582.x. Epub 2008 May 15.

Abstract

Objectives: There is growing concern about access to HIV/AIDS care among injection drug users (IDUs). We examined rates of CD4 cell count monitoring and correlates among HIV-infected IDUs.

Methods: This prospective observational cohort study of 460 community-recruited HIV-infected IDUs was situated in a Canadian city where all medical care is provided free of charge. Over a median follow-up period of 76 months, we evaluated factors associated with CD4 cell count monitoring through a linkage with a centralized CD4 registry.

Results: Overall, <5% of IDUs had CD4 monitoring consistent with local therapeutic guidelines. In multivariate analyses, after adjustment for being on antiretroviral therapy [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.84-2.70, P<0.001] female gender (OR 0.71, 95% CI 0.57-0.89, P=0.003), non-White ethnicity (OR 0.75, 95% CI 0.60-0.94, P=0.014), use of methadone maintenance therapy (OR 1.66, 95% CI 1.42-1.94, P<0.001) and daily heroin use (OR 0.72, 95% CI 0.61-0.85, P<0.001) were independently associated with CD4 monitoring.

Conclusions: Strategies to improve CD4 surveillance among IDUs are critically important, particularly for female and non-White IDUs. Expanded treatment for heroin dependence appears to have the greatest potential for improved care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Canada
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Guideline Adherence
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • Heroin Dependence / complications
  • Heroin Dependence / drug therapy
  • Humans
  • Male
  • Medication Adherence*
  • Methadone / therapeutic use
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Practice Guidelines as Topic
  • Substance Abuse, Intravenous* / complications
  • Substance Abuse, Intravenous* / drug therapy
  • Surveys and Questionnaires
  • Young Adult

Substances

  • Anti-HIV Agents
  • Methadone