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Michael Carter

Published: 12 August 2015

Beliefs about possible toxic interactions between antiretroviral therapy (ART) and illicit drugs are causing large numbers of people living with HIV who use drugs to intentionally miss doses of their HIV treatment when planning drug use, US investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

The prospective study involved 530 people reporting current drug use in Atlanta. All were taking ART and approximately a third reported missing treatment doses because of beliefs about potential interactions with drugs and alcohol. This planned non-adherence was associated with sub-optimal compliance to treatment and poor control of viral load.

“Our results showed that it was common for active drug users with HIV to believe that ART and drugs should not be mixed,” write the authors. “Outcomes from treatment were worse for individuals who said that they do stop taking their medications when using drugs.”

ART requires high levels of adherence and the best results are seen in people who take at least 85% of their doses. Previous research has shown that people with HIV who use drugs have an increased risk of poor adherence to ART because of intoxication. But little is known about whether beliefs about potential interactions between ART and illicit drugs or alcohol are causing drug users to intentionally skip doses of their HIV medication.

To address this gap in the current literature, a team of investigators designed a prospective study involving people living with HIV who were taking HIV treatment and actively using drugs.

Urine tests were used to identify patients with active drug use. Computerized self-interviews were then used to gather demographic information. Intentional non-adherence to ART when using illicit drugs was assessed by the question “I stop taking my HIV medications when I will be using drugs to get high.” The same question was asked regarding stopping medication when planning alcohol use. Participants in the study were also asked three questions to determine if they agreed with commonly held beliefs about the risk of adverse outcomes when mixing drugs or alcohol with ART.


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