HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use

• Published in: AIDS care Vol. 21; no. 5; pp. 655 - 663
• Main Authors: Chander, Geetanjali, Himelhoch, Seth, Fleishman, John A., Hellinger, James, Gaist, Paul, Moore, Richard D., Gebo, Kelly A.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis Group 01-05-2009; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active - trends; Antiviral agents; Biological and medical sciences; CD4-Positive T-Lymphocytes - metabolism; Comorbidity; Cross-Sectional Studies; Drug abuse; Drug addiction; Drug therapy; Drug use; Female; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; illicit drug use; Immune response system; Male; Medical sciences; Medical treatment; Mental disorders; Mental Disorders - epidemiology; Mental health; Middle Aged; Miscellaneous; Multivariate analysis; Pharmacology. Drug treatments; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; RNA, Viral; Substance-Related Disorders - epidemiology; Suppression; viral suppression; Young Adult; Antiretroviral agent; Multicenter study; Mental health; Pharmacotherapy; Cross sectional study; viral suppression; Antiviral; illicit drug use; Human; Immunopathology; Drug addiction; Drug combination; Illicit drug; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Concomitant disease; Treatment; HIV; Viral disease; Mental disorder; Human immunodeficiency virus
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540120802459762

Mental illness (MI) and illicit drug use (DU) frequently co-occur. We sought to determine the individual and combined effects of MI and DU on highly active antiretroviral therapy (HAART) receipt and HIV-RNA suppression among individuals engaged in HIV care. Using 2004 data from the HIV Research Network (HIVRN), we performed a cross-sectional study of HIV-infected patients followed at seven primary care sites. Outcomes of interest were HAART receipt and virological suppression, defined as an HIV-RNA <400 copies/ml. Independent variables of interest were: (1) MI/DU; (2) DU only; (3) MI only; and (4) Neither. We used chi-squared analysis for comparison of categorical variables, and logistic regression to adjust for age, race, sex, frequency of outpatient visits, years in clinical care, CD4 nadir, and study site. During 2004, 10,284 individuals in the HIVRN were either on HAART or HAART eligible defined as a CD4 cell count ≤350. Nearly half had neither MI nor DU (41%), 22% MI only, 15% DU only, and 22% both MI and DU. In multivariate analysis, co-occurring MI/DU was associated with the lowest odds of HAART receipt (Adjusted Odds Ratio: 0.63 (95% CI: (0.55-0.72]), followed by those with DU only (0.75(0.63-0.87)), compared to those with neither. Among those on HAART, concurrent MI/DU (0.66 (0.58-0.75)), DU only (0.77 (0.67-0.88)), were also associated with a decreased odds of HIV-RNA suppression compared to those with neither. MI only was not associated with a statistically significant decrease in HAART receipt (0.93(0.81-1.07)) or viral suppression (0.93 (0.82-1.05)) compared to those with neither. Post-estimation testing revealed a significant difference between those with MI/DU and DU only, and MI/DU and MI only. Co-occurring MI and DU is associated with lower HAART receipt and viral suppression compared to individuals with either MI or DU or neither. Integrating HIV, substance abuse, and mental healthcare may improve outcomes in this population.