ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2010
Temporal trends in highly active antiretroviral therapy initiation among injection drug users in Baltimore, Maryland, 1996-2008.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- Baltimore oral epidemiology, disease effects, and HIV evaluation study (BEEHIVE) study protocol: a prospective cohort study.BMC oral health · 2024Article
- Mortality among people who inject drugs: a prospective cohort followed over three decades in Baltimore, MD, USA.Addiction (Abingdon, England) · 2022Article
- HIV-positive persons who inject drugs experience poor health outcomes and unmet needs for care services.AIDS care · 2021Article
- Identifying, linking, and treating people who inject drugs and were recently infected with HIV in the context of a network-based intervention.AIDS care · 2019Article
- Increases in CD4Antiviral therapy · 2017Article
- A qualitative study of barriers to and facilitators of optimal engagement in care among PLWH and substance use/misuse.BMC research notes · 2016Article
- The Demand for Antiretroviral Drugs in the Illicit Marketplace: Implications for HIV Disease Management Among Vulnerable Populations.AIDS and behavior · 2015Article
- Level of adherence and HIV RNA suppression in the current era of highly active antiretroviral therapy (HAART).AIDS and behavior · 2015Article
- Unmet health care needs and hepatitis C infection among persons who inject drugs in Denver and Seattle, 2009.Prevention science : the official journal of the Society for Prevention Research · 2015Article
- Challenges in managing HIV in people who use drugs.Current opinion in infectious diseases · 2015Review
- Timing of antiretroviral therapy initiation in a nationally representative sample of HIV-infected adults receiving medical care in the United States.AIDS patient care and STDs · 2014Article
- Management of hepatitis C virus/HIV coinfection among people who use drugs in the era of direct-acting antiviral-based therapy.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2013Review
- Article
- Provider and clinic-level correlates of deferring antiretroviral therapy for people who inject drugs: a survey of North American HIV providers.Journal of the International AIDS Society · 2012Article
- Community-associated methicillin-resistant Staphylococcus aureus bacteremia and endocarditis among HIV patients: a cohort study.BMC infectious diseases · 2011Article
- Comprehensive Approaches to the Diagnosis and Treatment of HIV Infection in the Community: Can "Seek and Treat" Really Deliver?Current infectious disease reports · 2011Article
- Current and emerging research needs in studying the NYC HIV-drug use epidemic.Substance use & misuse · 2011Article
- Antiretroviral therapy: a promising HIV prevention strategy?Journal of acquired immune deficiency syndromes (1999) · 2010Article
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Abstract
backgroundWe characterized temporal trends in highly active antiretroviral therapy (HAART) initiation (1996-2008) among treatment-eligible persons in a community-based cohort of current and former injection drug users (IDUs) in Baltimore, Maryland.
methodsThe AIDS Linked to the IntraVenous Experience (ALIVE) cohort has been observing human immunodeficiency virus (HIV)-positive IDUs since 1988. HAART eligibility was defined as the first visit after 1 January 1996 at which the patient's CD4(+) cell count was <350 cells/microL. Temporal trends and predictors of HAART initiation were examined using chi(2) tests for trend and lognormal survival models.
resultsThe median age of 582 HAART-eligible IDUs was 41 years; 75% of the subjects were male, 97% were African American, and 60% were active IDUs. Of these 582 individuals, 345 initiated HAART over 1803 person-years (19.2 subjects per 100 person-years; 95% confidence interval, 17.2-21.3 subjects per 100 person-years); there was no statistically significant temporal trend in HAART initiation. Independent predictors of delayed initiation included heavy injection drug use; having a prior AIDS diagnosis, having a lower CD4(+) cell count, having a usual source of care, and having health insurance were predictors of more-rapid initiation. The delay between eligibility and initiation decreased among those who became eligible most recently (2003-2007), compared with those in earlier periods (1996-2002); however, a substantial number of patients who became eligible in recent years either initiated HAART after a substantial delay or did not initiate HAART at all.
conclusionsWe failed to observe substantial improvement in HAART initiation among current and former IDUs over a 12-year period; heavy use of injection drugs remains the major barrier to HAART initiation and to consistent HIV care. The fact that many IDUs initiate HAART after a significant delay or do not initiate it at all raises concern that disparities in HIV care for IDUs remain at a time of simplified antiretroviral regimens and increasing adoption of earlier treatment.
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