• B J Turner, J A Fleishman, N Wenger, A S London, M A Burnam, M F Shapiro, E G Bing, M D Stein, D Longshore, and S A Bozzette.
• Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pa 19104, USA. bturner@mail.med.upenn.edu
• J Gen Intern Med. 2001 Sep 1; 16 (9): 625633625-33.

ObjectiveTo distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use.DesignProspective population-based probability sample of 2,267 (representing 213,308) HIV-infected persons in care in the United States in early 1996.MeasurementsSelf-reported ART from first (January 1997-July 1997) to second (August 1997-January 1998) follow-up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first follow-up interview. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART.ResultsOf our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR, 0.74; CI, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97), severe drug abuse (AOR, 0.52; CI, 0.32 to 0.87), and HIV risk from injection drug use (AOR, 0.55; CI, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART (AOR, 1.57; CI, 1.11 to 2.08).ConclusionsDrug abuse-related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy.

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