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
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
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: