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Providers Defer HIV Treatment for Injection Drug Users (IDUs)

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People who abuse illegal drugs by injecting them are at much greater risk for contracting HIV than the rest of the population. Unfortunately, injection drug users (IDUs) who do contract HIV often do not receive standard antiretroviral therapy (ART) because of providers’ beliefs that IDUs are less likely to adhere to treatment, will not respond to it, and may develop resistant viral strains if treated. Research has not supported these concerns—studies have found similar survival rates and rates of drug resistance between IDUs and non-IDUs given ART—yet IDUs with HIV continue to be treated differently by healthcare providers.

To investigate factors leading to this disparity, an Internet-based study was conducted in which 662 U.S. and Canadian HIV treatment providers were surveyed about their attitudes about drug use and asked whether they would likely prescribe or delay ART treatment for hypothetical patients with different levels of drug use and with different levels of HIV infection.

Medical consensus is that any HIV-infected patient with a CD4+ cell count under 200 cells/mm3 (the threshold for a diagnosis of AIDS) should receive ART treatment, and nearly all the providers surveyed indicated they would give ART to such a patient who did not use drugs. But nearly a quarter of the providers surveyed in the study indicated they would defer ART for such a patient if he or she injected drugs occasionally, and over half indicated they would defer treatment if the patient injected on a daily basis. Providers were even more likely to defer ART treatment for drug users with lower levels of infection. Physicians were more likely than non-physician providers to defer ART for injection drug users, as were providers with less experience treating HIV and those whose clinics served populations with fewer injection drug users. These findings should inform future interventions aimed at healthcare providers to reduce healthcare disparities for drug users who are infected with HIV.

Top Graph: Providers likely to prescribe antiretroviral therapy (ART) for HIV-infected patients with a CD4+ cell count 200 cells per millimetercubed among non-injection drug users (97.9%) compared to daily injection drug users (47.6%).

Bottom Graph: Percentage of providers likely to prescribe antiretroviral therapy (ART) based on patient drug use.  The data is shown by the number of CD4+ cells a person has per millimeter cubed–including 200, 350, and 500 cells– and by the level of patient drug use including the following: No injection drug use, abstinent for 3 months, occasional injecting, and daily injecting.

No injection drug use: when CD4 is equal to 200 the percentage of providers likely to prescribe ART is 97.9, when CD4 is equal to 350 the percentage of providers likely to prescribe ART is 88.2, and when CD4 is equal to 500 the percentage of providers likely to prescribe ART is 38.5. Abstinent for 3 months: when CD4 is equal to 200 the percentage of providers likely to prescribe ART is 97.7, when CD4 is equal to 350 the percentage of providers likely to prescribe ART is 86.7, and when CD4 is equal to 500 the percentage of providers likely to prescribe ART is 32.8. Occasional injecting: when CD4 is equal to 200 the percentage of providers likely to prescribe ART is 75.8, when CD4 is equal to 350 the percentage of providers likely to prescribe ART is 51.7, and when CD4 is equal to 500 the percentage of providers likely to prescribe ART is 14.4. Daily injecting: when CD4 is equal to 200 the percentage of providers likely to prescribe ART is 47.6, when CD4 is equal to 350 the percentage of providers likely to prescribe ART is 29.6, and when CD4 is equal to 500 the percentage of providers likely to prescribe ART is 8.1.

Provider And Clinic-Level Correlates Of Deferring Antiretroviral Therapy For People Who Inject Drugs: A Survey Of North American HIV Providers. Westergaard RP, Ambrose BK, Mehta SH, Kirk GD. J Int AIDS Soc. 2012 Feb 23; 15:10.

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This page was last updated July 2012