Smoking, Alcohol Tied to Poor ART Adherence in US Smoking Trial 18/08/2012 Read more

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Author: Mark Mascolini

18 August 2012

Nicotine dependence, alcohol use, and illicit drug use independently raised the odds of poor adherence to antiretroviral therapy (ART) in a US trial. Depression raised chances of poor adherence in unadjusted statistical analyses.

Because recent studies suggest that smoking affects adherence to ART, researchers who conducted a randomized trial of smoking cessation performed a secondary analysis to identify factors associated with poor adherence.

The study included 326 HIV-positive people averaging 45.9 years in age (standard deviation 7.6). Approximately three quarters of study participants were men (72.1%) and African American (76.7%). Most study participants (70%) reported sexual contact as their mode of HIV acquisition.

Unadjusted logistic regression analysis identified three factors associated with poor adherence-depression (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00 to 1.04), illicit drug use (OR 2.39, 95% CI 1.51 to 3.79), and alcohol use (OR 2.86, 95%CI 1.79 to 4.57).

Logistic regression analysis adjusted for other factors that may affect adherence identified four independent predictors of poor adherence, at the following adjusted odds ratios (AOR):

• Nicotine dependence: AOR 1.13, 95% CI 1.02 to 1.25
• Illicit drug use: AOR 2.10, 95% CI 1.27 to 3.49
• Alcohol use: AOR 2.50, 95% CI 1.52 to 4.12
• Age: AOR 1.04, 95% CI 1.00 to 1.07

The researchers conclude that "nicotine dependence, illicit drug use, and alcohol use are potentially formidable barriers to ART adherence among [HIV-positive people] who smoke."

They see a need for further research to "investigate the complex relationships among these variables to improve adherence particularly among populations confronted with multifaceted health challenges."

Source: Rachel Marks King, Damon J. Vidrine, Heather E. Danysh, Faith E. Fletcher, Sheryl McCurdy, Roberto C. Arduino, Ellen R. Gritz. Factors associated with nonadherence to antiretroviral therapy in HIV-positive smokers. AIDS Patient Care and STDs. 2012; 26: 479-485.

For the study abstract

(Downloading the complete article requires a subscription to AIDS Patient Care and STDs or an online payment; the abstract is free.)