Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders

Abstract

This paper examines factors associated with adherence to antiretroviral medications (ARVs) in an HIV-infected population at high risk for non-adherence: individuals living with psychiatric and substance abuse disorders. Data were examined from baseline interviews of a multisite cohort intervention study of 1138 HIV-infected adults with both a psychiatric and substance abuse disorder (based on a structured psychiatric research interview using DSM-IV criteria). The baseline interview documented mental illness and substance use in the past year, mental illness and substance abuse severity, demographics, service utilization in the past three months, general health and HIV-related conditions, self-reported spirituality and self-reported ARV medication use. Among the participants, 62% were prescribed ARVs at baseline (n_542) and 45% of those on ARVs reported skipping medications in the past three days. Reports of non-adherence were significantly associated with having a detectable viral load (p < 01). The factors associated with non-adherence were current drug and alcohol abuse, increased psychological distress, less attendance at medical appointments, non-adherence to psychiatric medications and lower self-reported spirituality. Increased psychological distress was significantly associated with non-adherence, independent of substance abuse (p < .05). The data suggest that both mental illness and substance use must be addressed in HIV-infected adults living with these co-morbid illnesses to improve adherence to ARVs.

Use of HIV and Psychotropic Medications among Persons with Serious Mental Illness and HIV/AIDS

“…Little is known about the process and factors involved in taking both types of medication, thus, psychotropic medication may interact with HIVrelated medications in a negative manner (Thompson et al 2006) thus contributing to less continuity of psychotropic medication. This issue is relevant since non-adherence to psychiatric medications was found to be associated with non-adherence to antiretroviral medications in a study of HIV-infected individuals living with psychiatric and substance abuse disorders (Mellins et al 2009). Several studies have in fact shown that the management of psychiatric symptoms, associated with taking psychotropic drugs, is correlated with increased HAART adherence and better medical outcomes (Palmer et al 2010).…”

Harmful alcohol drinking among HIV-positive people in Nepal: an overlooked threat to anti-retroviral therapy adherence and health-related quality of life

“…Harmful alcohol drinking can also reduce coping skills and increase the likelihood of opportunistic infections [13]. Moreover, HIV-positive people who used illicit substances also had alcohol-use disorders resulting in non-adherence to ART [14]. …”

Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings

“…Earlier studies from varying regional settings have identified psychological distress as a barrier to optimal adherence. 46,47 Further in-depth studies in this patient population are needed to understand the impact of psychological function on treatment adherence, and psychosocial interventions (e.g., cognitive behavioral therapy) should be examined. 48 Having sex is an important part of overall health and quality of life, including patients infected with HIV.…”