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

Gabriel      V. Sanchez; Josep      M. Llibre; Marta      Torrens; Arantza      Sanvisens; Gerard      Mateu; Hernando      Knobel; Klaus      Langohr; Jose      R. Santos; Roberto      Muga

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