Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 203, Issue 9, Pages 1215-1221Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jir032
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Funding
- Abbott Laboratories
- Agouron Pharmaceuticals
- Boehringer Ingelheim Pharmaceuticals
- Borean Pharma AS
- Bristol-Myers Squibb
- DuPont Pharma
- Gilead Sciences
- GlaxoSmithKline
- Hoffmann-La Roche
- Immune Response Corporation
- Incyte
- Janssen-Ortho
- Kucera Pharmaceutical
- Merck Frosst Laboratories
- Pfizer Canada
- Sanofi Pasteur
- Shire Biochem
- Tibotec Pharmaceuticals
- Trimeris
- National Institutes of Health [R01DA021525]
- Canadian Institutes of Health Research [MOP-79297, RAA-79918]
- Michael Smith Foundation for Health Research
- Canadian Institutes of Health Research (CIHR)
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Background. Although some studies have identified impressive clinical gains for incarcerated HIV-seropositive injection drug users (IDUs) undergoing antiretroviral therapy (ART), the effect of incarceration on adherence to ART remains undetermined. Methods. We used data from a long-term community-recruited cohort of HIV-seropositive IDUs, including comprehensive ART dispensation records, in a setting where HIV care is free. We estimated the relationship between the cumulative burden of incarceration, measured longitudinally, and the odds of < 95% adherence to ART, with use of multivariate modeling. Results. From 1996 through 2008, 490 IDUs were recruited and contributed 2220 person-years of follow-up; 271 participants (55.3%) experienced an incarceration episode, with the number of incarcerations totaling 1156. In a multivariate model, incarceration had a strong dose-dependent effect on the likelihood of nonadherence to ART: 1-2 incarceration events (adjusted odds ratio [AOR], 1.49; 95% confidence interval [95% CI], 1.03-2.05), 3-5 events (AOR, 2.48; 95% CI, 1.62-3.65), and > 5 events (AOR, 3.11; 95% CI, 1.86-4.95). Conclusions. Among HIV-seropositive IDUs receiving ART, an increasing burden of incarceration was associated with poorer adherence in a dose-dependent fashion. Our findings support improved adherence support for HIV-seropositive IDUs experiencing incarceration.
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