Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2016

Open Access 01-12-2016 | Research article

Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study

Authors: Kanna Hayashi, Evan Wood, Thomas Kerr, Huiru Dong, Paul Nguyen, Cathy M. Puskas, Silvia Guillemi, Julio S. G. Montaner, Michael-John Milloy

Published in: BMC Infectious Diseases | Issue 1/2016

Login to get access

Abstract

Background

Crack cocaine use is known to contribute to poor adherence to antiretroviral medications; however, little is known about facilitators of or barriers to effective HIV treatment use among HIV-infected crack cocaine users. We sought to identify correlates of optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA viral load (pVL) suppression among this population.

Methods

Data from a prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, were linked to comprehensive HIV clinical monitoring and pharmacy dispensation records. We used multivariable generalized linear mixed-effects modelling to longitudinally identify factors associated with ≥95 % adherence to pharmacy refills for antiretroviral medications and pVL <50 copies/mL among crack cocaine users exposed to highly-active antiretroviral therapy (HAART).

Results

Among 438 HAART-exposed crack cocaine users between 2005 and 2013, 240 (54.8 %) had ≥95 % pharmacy refill adherence in the previous 6 months at baseline. In multivariable analyses, homelessness (adjusted odds ratio [AOR]: 0.58), ≥daily crack cocaine smoking (AOR: 0.64), and ≥ daily heroin use (AOR: 0.43) were independently associated with optimal pharmacy refill adherence (all p < 0.05). The results for pVL non-detectability were consistent with those of medication adherence, except that longer history of HAART (AOR: 1.06), receiving a single tablet-per-day regimen (AOR: 3.02) and participation in opioid substitution therapies was independently associated with pVL non-detectability (AOR: 1.55) (all p < 0.05).

Conclusions

Homelessness, and daily crack cocaine and/or heroin use were independently and negatively associated with optimal HAART-related outcomes. With the exception of opioid substitution therapies, no addiction treatment modalities assessed appeared to facilitate medication adherence or viral suppression. Evidence-based treatment options for crack cocaine use that also confer benefits to HAART need to be developed.
Literature
1.
Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis. 2013;26(1):17–25.CrossRefPubMed
2.
Montaner JS, Lima VD, Barrios R, Yip B, Wood E, Kerr T, et al. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet. 2010;376(9740):532–9.CrossRefPubMedPubMedCentral
3.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefPubMedPubMedCentral
4.
Des Jarlais DC, Mcknight C, Arasteh K, Feelemyer J, Perlman DC, Hagan H, et al. A perfect storm: crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City. Subst Use Misuse. 2014;49(7):783–92.CrossRefPubMedPubMedCentral
5.
Wechsberg WM, Golin C, El-Bassel N, Hopkins J, Zule W. Current interventions to reduce sexual risk behaviors and crack cocaine use among HIV-infected individuals. Curr HIV/AIDS Rep. 2012;9(4):385–93.CrossRefPubMedPubMedCentral
6.
Edlin BR, Irwin KL, Faruque S, McCoy CB, Word C, Serrano Y, et al. Intersecting epidemics--crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med. 1994;331(21):1422–7.CrossRefPubMed
7.
DeBeck K, Kerr T, Li K, Fischer B, Buxton J, Montaner J, et al. Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. CMAJ. 2009;181(9):585–9.CrossRefPubMedPubMedCentral
8.
World Health Organization, United Nations Office on Drugs and Crime, Joint United Nations Programme on HIV/AIDS. WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users: 2012 revision. Geneva: World Health Organization; 2012.
9.
Shoptaw S, Montgomery B, Williams CT, El-Bassel N, Aramrattana A, Metsch L, et al. Not just the needle: the state of HIV-prevention science among substance users and future directions. J Acquir Immune Defic Syndr. 2013;63 Suppl 2:S174–8.CrossRefPubMedPubMedCentral
10.
Meader N, Li R, Des Jarlais DC, Pilling S. Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users. Cochrane Database Syst Rev. 2010;1:CD007192.PubMed
11.
Joint United Nations Programme on HIV/AIDS. Fast-track: ending the AIDS epidemic by 2030. Geneva: Joint United Nations Programme on HIV/AIDS; 2014.
12.
Montaner JS, Wood E, Kerr T, Lima V, Barrios R, Shannon K, et al. Expanded highly active antiretroviral therapy coverage among HIV-positive drug users to improve individual and public health outcomes. J Acquir Immune Defic Syndr. 2010;55 Suppl 1:S5–9.CrossRefPubMed
13.
Arnsten JH, Demas PA, Grant RW, Gourevitch MN, Farzadegan H, Howard AA, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002;17(5):377–81.CrossRefPubMedPubMedCentral
14.
Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep. 2011;8(4):223–34.CrossRefPubMed
15.
Hinkin CH, Barclay TR, Castellon SA, Levine AJ, Durvasula RS, Marion SD, et al. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11(2):185–94.CrossRefPubMedPubMedCentral
16.
Strathdee SA, Palepu A, Cornelisse PGA, Yip B, O'Shaughnessy MV, Montaner JSG, et al. Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998;280(6):547–9.CrossRefPubMed
17.
Hogg RS, Heath KV, Yip B, Craib KJ, O'Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.CrossRefPubMed
18.
Hogg RS, Yip B, Chan KJ, Wood E, Craib KJP, O'Shaughnessy MV, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA. 2001;286(20):2568–77.CrossRefPubMed
19.
Low-Beer S, Yip B, O'Shaughnessy MV, Hogg RS, Montaner JS. Adherence to triple therapy and viral load response. J Acquir Immune Defic Syndr. 2000;23(4):360–1.CrossRefPubMed
20.
Wood E, Montaner JSG, Yip B, Tyndall MW, Schechter MT, O'Shaughnessy MV, et al. Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ. 2003;169(7):656–61.PubMedPubMedCentral
21.
Wood E, Hogg RS, Yip B, Harrigan PR, O'Shaughnessy MV, Montaner JSG. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 × 10(9) cells/L. Ann Intern Med. 2003;139(10):810–6.CrossRefPubMed
22.
Lima VD, Harrigan R, Murray M, Moore DM, Wood E, Hogg RS, et al. Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS. 2008;22(17):2371–80.CrossRefPubMed
23.
Brecht M-L, Huang D, Evans E, Hser Y-I. Polydrug use and implications for longitudinal research: ten-year trajectories for heroin, cocaine, and methamphetamine users. Drug Alcohol Depend. 2008;96(3):193–201.CrossRefPubMedPubMedCentral
24.
Bruce RD, Altice FL, Friedland GH. Pharmacokinetic drug interactions between drugs of abuse and antiretroviral medications: implications and management for clinical practice. Expert Rev Clin Pharmacol. 2008;1(1):115–27.CrossRefPubMed
25.
26.
Ingersoll KS, Farrell-Carnahan L, Cohen-Filipic J, Heckman CJ, Ceperich SD, Hettema J, et al. A pilot randomized clinical trial of two medication adherence and drug use interventions for HIV+ crack cocaine users. Drug Alcohol Depend. 2011;116(1-3):177–87.CrossRefPubMedPubMedCentral
27.
Knapp WP, Soares BGO, Farrel M, Lima MS. Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev. 2007;3:CD003023.PubMed
28.
Castells X, Casas M, Perez-Mana C, Roncero C, Vidal X, Capella D. Efficacy of psychostimulant drugs for cocaine dependence. Cochrane Database Syst Rev. 2010;2:CD007380.PubMed
29.
Minozzi S, Amato L, Davoli M, Farrell M, Lima Reisser AARL, Pani PP, et al. Anticonvulsants for cocaine dependence. Cochrane Database Syst Rev. 2008;2:CD006754.PubMed
30.
Kim JH, Lawrence AJ. Drugs currently in Phase II clinical trials for cocaine addiction. Expert Opin Investig Drugs. 2014;23(8):1105–22.CrossRefPubMed
31.
Spire B, Lucas GM, Carrieri MP. Adherence to HIV treatment among IDUs and the role of opioid substitution treatment (OST). Int J Drug Policy. 2007;18(4):262–70.CrossRefPubMed
32.
Roux P, Carrieri MP, Villes V, Dellamonica P, Poizot-Martin I, Ravaux I, et al. The impact of methadone or buprenorphine treatment and ongoing injection on highly active antiretroviral therapy (HAART) adherence: evidence from the MANIF2000 cohort study. Addiction. 2008;103(11):1828–36.CrossRefPubMed
33.
Gonzalez A, Mimiaga MJ, Israel J, Andres Bedoya C, Safren SA. Substance use predictors of poor medication adherence: the role of substance use coping among HIV-infected patients in opioid dependence treatment. AIDS Behav. 2013;17(1):168–73.CrossRefPubMedPubMedCentral
34.
Roux P, Lions C, Michel L, Cohen J, Mora M, Marcellin F, et al. Predictors of non-adherence to methadone maintenance treatment in opioid-dependent individuals: implications for clinicians. Curr Pharm Des. 2014;20(25):4097–105.CrossRefPubMed
35.
Marsden J, Eastwood B, Bradbury C, Dale-Perera A, Farrell M, Hammond P, et al. Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study. Lancet. 2009;374(9697):1262–70.CrossRefPubMed
36.
Milloy MJ, Kerr T, Bangsberg DR, Buxton J, Parashar S, Guillemi S, et al. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting. AIDS Patient Care STDS. 2012;26(1):60–7.CrossRefPubMedPubMedCentral
37.
Darke S. Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998;51(3):253–63. discussion 267–8.CrossRefPubMed
Metadata
Title
Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study
Authors
Kanna Hayashi
Evan Wood
Thomas Kerr
Huiru Dong
Paul Nguyen
Cathy M. Puskas
Silvia Guillemi
Julio S. G. Montaner
Michael-John Milloy
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2016
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-016-1749-y

Other articles of this Issue 1/2016

BMC Infectious Diseases 1/2016 Go to the issue

Research article

Association of HLA class I and II genes with cutaneous leishmaniasis: a case control study from Sri Lanka and a systematic review

Research article

ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study

Study protocol

A prospective cohort study to assess seroprevalence, incidence, knowledge, attitudes and practices, willingness to pay for vaccine and related risk factors in dengue in a high incidence setting

Research article

The efficacy of thymosin α1 as immunomodulatory treatment for sepsis: a systematic review of randomized controlled trials

Research article

Molecular Characterization of Giardia duodenalis in Children in Kenya

Research article

Diagnostic accuracy of peripheral venous lactate and the 2009 WHO warning signs for identifying severe dengue in Thai adults: a prospective observational study

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits