The success of highly active antiretroviral therapy (HAART) among persons living with HIV is largely dependent on strict medication adherence. Recent research suggests that alcohol and other drug use (AOD) may be an important barrier to HAART adherence. In this study, we examined the impact of AOD on HAART adherence as well as the moderating effects of general and medication-specific social support. The data were collected as part of a longitudinal randomized control trial with 224 HIV-positive patients at an HIV primary care clinic in the northwestern United States. Findings indicated that AOD use was negatively associated with HAART adherence and that medication-specific (but not general) social support moderated the AOD-adherence association at 3 (but not at 6 or 9) months. Results indicate the importance of medication-specific social support to treat comorbid AOD use and HIV; implications for future research and intervention programs for HIV-positive AOD users are discussed.
Get full access to this article
View all access options for this article.
References
1.
CrumNF, RiffenburghRH, WegnerSet al.Comparisons of causes of death and mortality rates among HIV-infected persons: Analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr, 2006; 41:194–200.
2.
JonesJ, TaylorB, WilkinTJ, HammerSM. Advances in antiretroviral therapy. Top HIV Med, 2007; 15:48–82.
3.
GardnerEM, SharmaS, PengGet al.Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance. AIDS, 2008; 22:75–82.
4.
MaggioloF, AiroldiM, KleinloogHDet al.Effect of adherence to HAART on virologic outcome and on the selection of resistance-conferring mutations in NNRTI- or PI-treated patients. HIV Clin Trials, 2007; 8:282–292.
5.
LimaVD, HarriganR, BangsbergDRet al.The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr, 2009; 50:529–536.
6.
ConwayB. The role of adherence to antiretroviral therapy in the management of HIV infection. J Acquir Immune Defic Syndr, 2007; 45,Suppl 1:S14–18.
7.
BingEG, BurnamMA, LongshoreDet al.Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry, 2001; 58:721–728.
8.
CookRL, SereikaSM, HuntSC, WoodwardWC, ErlenJA, ConigliaroJ. Problem drinking and medication adherence among persons with HIV infection. J Gen Intern Med., 2001; 16:83–88.
9.
GalvanFH, BingEG, FleishmanJAet al.The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: Results from the HIV Cost and Services Utilization Study. J Stud Alcohol, 2002; 63:179–186.
10.
SametJH, HortonNJ, MeliS, FreedbergKA, PalepuA. Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems. Alcohol Clin Exp Res, 2004; 28:572–577.
11.
GreenfieldTK, MidanikLT, RogersJD. A 10-year national trend study of alcohol consumption, 1984–1995: Is the period of declining drinking over?Am J Public Health, 2000; 90:47–52.
12.
GordilloV, delAmo J, SorianoV, González-LahozJ. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS, 1999; 13:1763–1769.
13.
HendershotCS, StonerSA, PantaloneDW, SimoniJM. Alcohol use and antiretroviral adherence: Review and meta-analysis. J Acquir Immune Defic Syndr., 2009; 52:180–202.
14.
MaltaM, StrathdeeSA, MagnaniniMM, BastosFI. Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: A systematic review. Addiction, 2008; 103:1242–1257.
15.
MurphyDA, MarelichWD, HoffmanD, SteersWN. Predictors of antiretroviral adherence. AIDS Care, 2004; 16:471–484.
16.
HolmesWC, BilkerWB, WangH, ChapmanJ, GrossR. HIV/AIDS-specific quality of life and adherence to antiretroviral therapy over time. J Acquir Immune Defic Syndr, 2007; 46:323–327.
17.
MurphyDA, GreenwellL, HoffmanD. Factors associated with antiretroviral adherence among HIV-infected women with children. Women Health, 2002; 36:97–111.
18.
PowerR, KoopmanC, VolkJet al.Social support, substance use, and denial in relationship to antiretroviral treatment adherence among HIV-infected persons. AIDS Patient Care STDs, 2003; 17:245–252.
19.
BrysonCL, AuDH, SunH, WilliamsEC, KivlahanDR, BradleyKA. Alcohol screening scores and medication nonadherence. Ann Intern Med, 2008; 149:795–804.
20.
ChanderG, LauB, MooreRD. Hazardous alcohol use: A risk factor for non-adherence and lack of suppression in HIV infection. J Acquir Immune Defic Syndr, 2006; 43:411–417.
21.
CelentanoDD, VlahovD, CohnS, ShadleVM, ObasanjoO, MooreRD. Self-reported antiretroviral therapy in injection drug users. JAMA, 1998; 280:544–546.
22.
LucasGM, GeboKA, ChaissonRE, MooreRD. Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS, 2002; 16:767–774.
23.
AmmassariA, MurriR, PezzottiPet al.Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. J Acquir Immune Defic Syndr, 2001; 28:445–449.
24.
Peretti-WatelP, SpireB, LertF, ObadiaY, GroupV. Drug use patterns and adherence to treatment among HIV-positive patients: Evidence from a large sample of French outpatients (ANRS-EN12-VESPA 2003)Drug Alcohol Depend, 2006; 82,Suppl 1:S71–79.
25.
CatzSL, KellyJA, BogartLM, BenotschEG, McAuliffeTL. Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol, 2000; 19:124–133.
26.
KalichmanSC, RompaD. HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy. Sex Transm Infect, 2003; 79:59–61.
27.
MartiniM, RecchiaE, NastaPet al.Illicit drug use: can it predict adherence to antiretroviral therapy?Eur J Epidemiol, 2004; 19:585–587.
28.
MohammedH, KieltykaL, Richardson-AlstonGet al.Adherence to HAART among HIV-infected persons in rural Louisiana. AIDS Patient Care STDs, 2004; 18:289–296.
29.
SimoniJM, FrickPA, HuangB. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol, 2006; 25:74–81.
30.
DiMatteoMR, LepperHS, CroghanTW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med, 2000; 160:2101–2107.
31.
GodinG, CôtéJ, NaccacheH, LambertLD, TrottierS. Prediction of adherence to antiretroviral therapy: a one-year longitudinal study. AIDS Care, 2005; 17:493–504.
32.
PrattRJ, RobinsonN, LovedayHPet al.Adherence to antiretroviral therapy: Appropriate use of self-reporting in clinical practice. HIV Clin Trials, 2001; 2:146–159.
33.
AtkinsonJS, SchönnessonLN, WilliamsML, TimpsonSC. Associations among correlates of schedule adherence to antiretroviral therapy (ART): A path analysis of a sample of crack cocaine using sexually active African-Americans with HIV infection. AIDS Care, 2008; 20:253–262.
34.
RobertsKJ. Physician-patient relationships, patient satisfaction, and antiretroviral medication Adherence among HIV-infected adults attending a public health clinic. AIDS Patient Care STDs, 2002; 16:43–50.
35.
BroadheadRS, HeckathornDD, AlticeFLet al.Increasing drug users' adherence to HIV treatment: Results of a peer-driven intervention feasibility study. Soc Sci Med, 2002; 55:235–246.
36.
CarrieriMP, ChesneyMA, SpireBet al.Failure to maintain adherence to HAART in a cohort of French HIV-positive injecting drug users. Int J Behav Med, 2003; 10:1–14.
37.
KnowltonA, ArnstenJ, EldredLet al.Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users. J Acquir Immune Defic Syndr, 2006; 41:486–492.
38.
SimoniJM, HuhD, FrickPA, PearsonCR, AndrasikMP, DunbarPJ, HootonTM. Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial. J Acquir Immune Defic Syndr, 2009; 52:465–473.
39.
SaundersJB, AaslandOG, BaborTF, de la FuenteJR, GrantM. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—II. Addiction, 1993; 88:791–804.
40.
FiellinDA, ReidMC, O'ConnorPG. Screening for alcohol problems in primary care: A systematic review. Arch Intern Med, 2000; 160:1977–1989.
41.
PrentissD, PowerR, BalmasG, TzuangG, IsraelskiDM. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting. J Acquir Immune Defic Syndr, 2004; 35:38–45.
42.
SherbourneCD, StewartAL. The MOS social support survey. Soc Sci Med, 1991; 32:705–714.
43.
van BuurenS, BrandsJPL, Groothuis-OudshoornCGM, RubinDB. Fully conditional specification in multivariate imputation. J Stat Comput Simul, 2006; 76:1049–1064.
44.
RaudenbushSW, BrykAS. Hierarchical Linear Models: Applications and Data Analysis Methods. Sage, 2002.
45.
AikenL, WestS. Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage, 1991.
46.
FogartyL, RoterD, LarsonS, BurkeJ, GillespieJ, LevyR. Patient adherence to HIV medication regimens: A review of published and abstract reports. Patient Educ Couns., 2002; 46:93–108.
47.
DarbesLA, LewisMA. HIV-specific social support predicts less sexual risk behavior in gay male couples. Health Psychol, 2005; 24:617–622.
48.
RuedaS, Park-WyllieLY, BayoumiAMet al.Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev, 2006; 3:CD001442.
49.
ParsonsJT, GolubSA, RosofE, HolderC. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: A randomized controlled trial. J Acquir Immune Defic Syndr, 2007; 46:443–450.
50.
AntoniouT, TsengAL. Interactions between recreational drugs and antiretroviral agents. Ann Pharmacother, 2002; 36:1598–1613.
51.
CrystalS, SambamoorthiU, MoynihanPJ, McSpirittE. Initiation and continuation of newer antiretroviral treatments among medicaid recipients with AIDS. J Gen Intern Med, 2001; 16:850–859.
52.
TeggerMK, CraneHM, TapiaKA, UldallKK, HolteSE, KitahataMM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDs, 2008; 22:233–243.
53.
ShachamE, NurutdinovaD, OnenN, StammK, OvertonET. The interplay of sociodemographic factors on virologic suppression among a U.S. outpatient HIV clinic population. AIDS Patient Care STDs, 2010; 24:229–235.
54.
Powell-CopeGM, WhiteJ, HenkelmanEJ, TurnerBJ. Qualitative and quantitative assessments of HAART adherence of substance-abusing women. AIDS Care., 2003; 15:239–249.
55.
ReynoldsNR. Adherence to antiretroviral therapies: state of the science. Curr HIV Res, 2004; 2:207–214.
56.
BouhnikAD, ChesneyM, CarrieriPet al.Nonadherence among HIV-infected injecting drug users: The impact of social instability. J Acquir Immune Defic Syndr., 2002; 31,Suppl 3:S149–153.
57.
SankarA, WunderlichT, NeufeldS, LuborskyM. Sero-positive African Americans' beliefs about alcohol and their impact on anti-retroviral adherence. AIDS Behav, 2007; 11:195–203.
58.
KalichmanSC, AmaralCM, WhiteDet al.Prevalence and clinical implications of interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapies among people living with HIV/AIDS. AIDS Patient Care STDs, 2009; 23:449–454.
59.
HinkinCH, HardyDJ, MasonKIet al.Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS, 2004; 18,Suppl 1:S19–25.
60.
ParsonsJT, RosofE, MustanskiB. Patient-related factors predicting HIV medication adherence among men and women with alcohol problems. J Health Psychol., 2007; 12:357–370.
61.
RothlindJC, GreenfieldTM, BruceAVet al.Heavy alcohol consumption in individuals with HIV infection: Effects on neuropsychological performance. J Int Neuropsychol Soc, 2005; 11:70–83.
62.
PearsonCR, SimoniJM, HoffP, KurthAE, MartinDP. Assessing antiretroviral adherence via electronic drug monitoring and self-report: An examination of key methodological issues. AIDS Behav, 2007; 11:161–173.
63.
SimoniJM, KurthAE, PearsonCR, PantaloneDW, MerrillJO, FrickPA. Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behav, 2006; 10:227–245.
64.
RosenthalJA. Qualitative descriptors of strength of association and effect size. J Soc Service Res, 1996; 21:37.
65.
CarricoAW, JohnsonMO, ColfaxGN, MoskowitzJT. Affective correlates of stimulant use and adherence to anti-retroviral therapy among HIV-positive methamphetamine users. AIDS Behav, 2010; 14:769–777.
