Department of Medicine (Division of General Internal Medicine), Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, United States.
Drug Alcohol Depend. 2012 Jan 1;120(1-3):174-80. doi: 10.1016/j.drugalcdep.2011.07.025. Epub 2011 Aug 31.
The impact of adherence enhancing interventions on the relationship between active drug use and adherence is largely unknown.
We conducted a 24-week randomized controlled trial of antiretroviral directly observed therapy (DOT) vs. treatment as usual (TAU) among HIV-infected methadone patients. Our outcome measure was pill count antiretroviral adherence, and our major independent variables were treatment arm (DOT vs. TAU) and active drug use (opiates, cocaine, or both opiates and cocaine). We defined any drug use as ≥ 1 positive urine toxicology result, and frequent drug use as ≥ 50% tested urines positive. We used mixed-effects linear models to evaluate associations between adherence and drug use, and included a treatment arm-by-drug use interaction term to evaluate whether DOT moderates associations between drug use and adherence.
39 participants were randomized to DOT and 38 to TAU. We observed significant associations between adherence and active drug use, but these were limited to TAU participants. Adherence was worse in TAU participants with any opiate use than in TAU participants without (63% vs. 75%, p<0.01); and worse among those with any polysubstance (both opiate and cocaine) use than without (60% vs. 73%, p=0.01). We also observed significant decreases in adherence among TAU participants with frequent opiate or frequent polysubstance use, compared to no drug use. Among DOT participants, active drug use was not associated with worse adherence.
Active opiate or polysubstance use decreases antiretroviral adherence, but the negative impact of drug use on adherence is eliminated by antiretroviral DOT.
增强依从性干预对积极用药与依从性之间关系的影响在很大程度上尚不清楚。
我们对感染 HIV 的美沙酮患者进行了一项为期 24 周的抗逆转录病毒直接观察治疗（DOT）与常规治疗（TAU）的随机对照试验。我们的结局测量是药片计数抗逆转录病毒依从性，我们的主要独立变量是治疗组（DOT 与 TAU）和积极用药（阿片类药物、可卡因或阿片类药物和可卡因）。我们将任何药物使用定义为≥1 个阳性尿液毒理学结果，频繁药物使用定义为≥50%测试尿液阳性。我们使用混合效应线性模型来评估依从性与药物使用之间的关联，并包括一个治疗组-药物使用交互项，以评估 DOT 是否调节药物使用与依从性之间的关联。
39 名参与者被随机分配到 DOT 组，38 名参与者被分配到 TAU 组。我们观察到依从性与积极用药之间存在显著关联，但这些关联仅限于 TAU 参与者。与无阿片类药物使用的 TAU 参与者相比，有任何阿片类药物使用的 TAU 参与者的依从性更差（63%对 75%，p<0.01）；与无阿片类药物和可卡因使用的 TAU 参与者相比，有任何阿片类药物和可卡因使用的 TAU 参与者的依从性更差（60%对 73%，p=0.01）。我们还观察到，与无药物使用相比，阿片类药物或阿片类药物和可卡因频繁使用的 TAU 参与者的依从性显著下降。在 DOT 参与者中，积极用药与较差的依从性无关。
积极使用阿片类药物或多药会降低抗逆转录病毒的依从性，但抗逆转录病毒 DOT 消除了药物使用对依从性的负面影响。
