Half of HIV-Positive Drug Users Not Receiving HIV Treatment

Half of HIV-Positive Drug Users Not Receiving HIV Treatment

Embargoed For Release: Tuesday, August 11, 3:00pm CST
Contact: Lisbeth Pettengill (410)-955-6878 or [email protected]

Two studies by researchers at the Johns Hopkins School of Public Health and the University of British Columbia in Canada have shown that roughly half the HIV-infected injection drug users studied who were eligible for lifesaving antiretroviral therapy were not receiving it. Both reports appeared in the August 12 issue of JAMA.

One of the studies, conducted by researchers at the Johns Hopkins School of Public Health, has shown that only half of HIV-positive injection drug users in Baltimore were receiving proven HIV therapies, even though many were no longer using illicit drugs.

A companion study by researchers at the University of British Columbia and Centre for Excellence in HIV/AIDS found that 60 percent of HIV-positive injection drug users were not receiving any antiretroviral therapy, despite universal health care and the availability of free HIV therapies in Canada. On average, the HIV-positive drug users in Vancouver had been eligible to receive free HIV therapies for over a year.

Correct use of double or triple combinations of proven antiretroviral therapies can prolong life and reduce levels of HIV in the bloodstream. However, some doctors believe that these costly medications should not be prescribed to HIV-infected persons who may not be able to adhere to their complex treatment regimens.

"What this shows is that universal health care does not necessarily mean universal access to HIV antiretroviral therapy," said lead author of the Vancouver study, Steffanie Strathdee, PhD, who has since joined the Johns Hopkins School of Public Health as associate professor, Epidemiology. "Ninety percent of all HIV-infected persons live in developing countries, where there is often no access to these therapies. Our studies show that even in North America, the best HIV treatments are not reaching those who need them the most."

Lead author of the Baltimore study, David D. Celentano, ScD, professor, Epidemiology, Johns Hopkins School of Public Health said, "The trouble is, former addicts in stable living situations are also being denied this therapy. Clinicians may be thinking, 'Once an IDU, always an IDU,' and therefore they withhold proper therapy to these patients."

According to the authors of the Baltimore study, investigations have shown that prior drug users, once they are in recovery and have stopped injecting illicit drugs, can comply with complex medication regimens just as faithfully as those who have never touched illicit drugs.

The Baltimore study involved a total of 404 HIV-infected active and former injection drug users. Half reported no recent antiretroviral therapy, with most former addicts reporting no use of triple combination therapies that include a potent protease inhibitor. In contrast, the majority of drug users studied in Vancouver who were receiving HIV therapy were receiving double or triple combination therapies that are in agreement with current international guidelines.

In the Vancouver study, female drug users were half as likely to receive HIV therapy as males, while drug users not enrolled in drug or alcohol treatment programs were three times less likely to receive HIV treatment. Most striking was the fact that drug users who had physicians with the least experience treating HIV infection were five times less likely to receive therapy.

The authors recommended that delivery of HIV therapies be expanded to all HIV-infected persons who meet recognized international guidelines. They called for increased supports from drug abuse treatment programs, economic assistance programs and prisons to help HIV-infected persons access and adhere to complex HIV regimens. Since continued injection drug use complicates access to HIV treatments and adherence, the investigators believed it crucial that HIV infection and substance abuse are treated simultaneously. They also urged for enhanced education oriented towards physicians and drug users to improve utilization of these lifesaving treatments.

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The Baltimore study was supported in part by a grant from the National Institute on Drug Abuse; the Vancouver study received funding from the British Columbia Ministry of Health and Health Canada; the National Health Research Development Programme of the Department of Health Canada; and the St. Paul's Hospital Foundation.