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Current HIV Research
ISSN (Print): 1570-162X
ISSN (Online): 1873-4251
VOLUME: 10
ISSUE: 4
DOI: 10.2174/157016212800792504      Price:  $58









Effectiveness of Antiretroviral Therapy in HIV-1-Infected Active Drug Users Attended in a Drug Abuse Outpatient Treatment Facility Providing a Multidisciplinary Care Strategy

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Author(s): Gabriel V. Sanchez, Josep M. Llibre, Marta Torrens, Arantza Sanvisens, Gerard Mateu, Hernando Knobel, Klaus Langohr, Jose R. Santos and Roberto Muga
Pages 356-363 (8)
Abstract:
Objective: HIV-1-infected active drug users (ADU) obtain smaller clinical benefits with antiretroviral therapy (HAART) compared to non-ADU subjects with sexually-transmitted HIV-1 infection. Therefore treatment strategies are required to address the specific issues arising in this challenging scenario. We describe the effectiveness of HAART provided in a drug abuse outpatient treatment facility through a comprehensive integrated care that includes medical, drug dependence, and psychosocial support.

Methods: We included all consecutive HIV-1-infected ADU admitted for drug dependency treatment and who started their first HAART. A comparator arm consisted of a control group of sexually transmitted HIV-1-infected subjects attended in a reference hospital under standard care. The strategy did not include directly observed treatment.

Results: A total of 71 ADU and 48 matched subjects infected through sexual transmission were included. ADU had lower baseline CD4+ T-cell counts (196 vs 279 cells/μL, P=.001), and more advanced CDC stages (P=.001). The estimated probabilities of patients with virological response (<50 copies/mL) at weeks 48 and 96 were 92.9% (95%-CI: 87.1%—99.1%) and 87.3% (95%-CI: 78.7%—95.2% for ADU, and 93.7%(95%-CI: 84.1%—99.8%) and 87.5% (95%-CI: 77.5%—97.3%) for sexually-infected subjects (P= .1325 and .241). Kaplan-Meier estimates of time to loss of virological response did not show differences between groups (log rank test, P=.965).

Conclusions: An integrated multidisciplinary care of HIV-1-infected antiretroviral naïve ADU provided in a drug abuse treatment center obtains high rates of virological suppression, similar to those observed in a comparison group of sexually-transmitted HIV-1-infected subjects. This strategy should be further evaluated in public health programs and assessed in randomized trials.

Keywords:
Active drug users, HAART, antiretroviral effectiveness, treatment adherence, multidisciplinary care, HIV-1, CD4, ADU, NRTIs, cohort
Affiliation:
Department of Internal Medicine, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.