Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons

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.