Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug Users

Arnsten, Julia H.; Demas, Penelope; Grant, Richard W.; Gourevitch, Marc N.; Farzadegan, Homayoon; Howard, Andrea A.; Schoenbaum, Ellie E.

doi:10.1046/j.1525-1497.2002.10644.x

Cited by 301 publications

(233 citation statements)

References 22 publications

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“…Cocaine use is associated with a 41% decline in median antiretroviral adherence and is a strong predictor of failure to maintain viral load (Arnsten et al, 2002). Golin et al (2002) found that active substance and alcohol users take significantly fewer doses of HAART medication than substance-free clients.…”

Section: Introductionmentioning

confidence: 99%

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

Sorensen

Haug

Delucchi

et al. 2007

Drug and Alcohol Dependence

145

136

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This clinical trial evaluated a contingency management intervention designed to improve medication adherence among HIV-positive methadone maintenance patients. After a 4-week baseline observation phase, eligible participants (N = 66) were randomly assigned to: (a) medication coaching sessions every other week to assist with adherence strategies (comparison group) or (b) medication coaching plus voucher reinforcement for opening electronic medication caps on time (voucher group). Baseline adherence (percent doses taken/percent total possible doses) was 51% using electronic measurement, 75% using self-report and 75% using pill count. The intervention was provided for 12 weeks, with a 4-week follow-up. The primary outcome results of the clinical trial indicated effectiveness during the intervention, with significant mean adherence differences between voucher and comparison groups using electronic measurement (78% vs. 56%), pill count (86% vs. 75%), and self-report (87% vs. 69%). Differences between groups faded after vouchers were discontinued. Contingency management shows promise as a strategy to promote antiretroviral medication adherence in this population.

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Section: Introductionmentioning

confidence: 99%

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

Sorensen

Haug

Delucchi

et al. 2007

Drug and Alcohol Dependence

145

136

View full text Add to dashboard Cite

show abstract

“…Repeated attempts to identify individual traits or characteristics (e.g., demographics) that correlate with adherence have failed (Reynolds, 2004), although several studies have associated older age with increased adherence (e.g., Hinkin, Hardy, & Hardy, 2004). Attention has thus shifted to potentially improving adherence by identifying modifiable features associated with adherence such as substance use (Ferrando, Wall, Batki, & Sorensen, 1996), depression (Arnsten et al, 2002), forgetfulness (Fong et al, 2003), and isolation (Altice, Mostashari, & Friedland, 2001). …”

Section: Introductionmentioning

confidence: 99%

Sero-positive African Americans’ Beliefs about Alcohol and Their Impact on Anti-retroviral Adherence

et al. 2006

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Alcohol consumption has been associated with HIV disease progression; yet, the nature of this association is poorly understood. This study sought to determine the influence of patient beliefs about alcohol on ART adherence, and elucidate clinician beliefs about drinking and taking ART. Most patients (85%) believed alcohol and ART do not mix. The three alcohol consumption groups, light, moderate, and heavy, differed in their beliefs about drinking and ART with 64% of light and 55% of moderate drinkers skipping ART when drinking compared to 29% of heavy drinkers. Beliefs were derived from folk models of alcohol-ART interaction. Patients 50 and older were less likely to skip ART when drinking. Alcohol appears to affect adherence through decisions to forgo ART when drinking not through drunken forgetfulness. Furthermore, over onehalf of clinicians believed alcohol and ART should not be taken together. These findings have implications for patient care and physician training.

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“…Further, cocaine directly influences the immune system as demonstrated by increases in TNF alpha and IL-6 production after cocaine exposure and excessive exposure to these proinflammatory cytokines could be detrimental to brain tissue [see Review (Tyor and Middaugh, 1999)]. Thus, in addition to reducing HIV medication compliance (Arnsten et al, 2002), these findings suggest that cocaine abuse is capable of accelerating HIV-associated complications.…”

Section: Introductionmentioning

confidence: 99%

Chronic cocaine exposure in the SCID mouse model of HIV encephalitis

2007

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Clinical and preclinical evidence suggests that cocaine exposure hastens progression of the HIV disease process. An established active, euphoric dose of cocaine (20 mg/kg) was administered to SCID mice according to a regimen consistent with exposure to the drug by cocaine-abusing HIVinfected patients to determine the effects of cocaine on four previously established pathological characteristics of HIV encephalitis: cognitive deficits, fatigue, astrogliosis, and microgliosis. Mice were intracranially inoculated with either HIV-infected, or uninfected macrophages and then injected with either cocaine or saline in a 2(Infection) × 2(Cocaine) factorial design. Cognition was assessed by acquisition and retention of a spatially cued learning task. Fatigue was assessed by monitoring motor activity following a 2 minute forced swim. Mice were then sacrificed to determine the extent of astrogliosis and microgliosis in the four groups. Results indicated that in comparison to uninfected controls, HIV positive mice had increased astrogliosis and microgliosis, cognitive deficits, and recovered more slowly from fatigue. However, despite evidence that the cocaine exposure regimen activated the central nervous system and had long-term CNS effects, the drug did not alter the behavioral or the neuropathological deficits noted in HIV-infected SCID mice.

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Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug Users

Cited by 301 publications

References 22 publications

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

Sero-positive African Americans’ Beliefs about Alcohol and Their Impact on Anti-retroviral Adherence

Chronic cocaine exposure in the SCID mouse model of HIV encephalitis

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