Adherence to Antiretroviral Therapy Among HIV-Infected Drug Users: A Meta-Analysis |
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Authors: | Monica Malta Monica M F Magnanini Steffanie A Strathdee Francisco I Bastos |
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Institution: | (1) Social Science Department, Sergio Arouca School of Public Health (DCS/ENSP), Oswaldo Cruz Foundation, Rua Leopoldo Bulhoes, 1480, Room 905, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil;(2) Institute of Public Health Studies, Federal University of Rio de Janeiro (IESC/UFRJ), Rio de Janeiro, Brazil;(3) Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine at University of California, San Diego (UCSD) School of Medicine, San Diego, CA, USA;(4) Health Information Laboratory, Center for Scientific and Technological Information (LIS/ICICT), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil |
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Abstract: | We conducted a meta-analysis of studies assessing adherence to highly active antiretroviral therapy (HAART) and a qualitative
systematic review of factors associated with better HAART outcomes among HIV+ drug users (DU). Thirty-eight studies were considered,
which analyzed 14,960 patients (11,394 HIV+ DU, 76.2%). Overall adherence (pooled percent of DU classified as adherent in
each study) was 0.60 (95% CI: 0.52–0.68), similar to levels identified by studies conducted with HIV+ patients who are not
drug users. Time frame used to measure adherence was an independent predictor of inter-study heterogeneity. The systematic
review identified better HAART outcomes among former DU, those with less severe psychiatric conditions, those receiving opioid
substitution therapy and/or psychosocial support. Patients initiating HAART with lower viral load and higher CD4 counts, and
those without co-infections also had better treatment outcomes. Our findings suggest that HIV+ DU tend to be inappropriately
assumed to be less adherent and unlikely to achieve desirable treatment outcomes, when compared to their non-DU cohort. |
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