Time to initiating highly active antiretroviral therapy among HIV-infected injection drug users

David D. Celentano, Noya Galai, Ajay K. Sethi, Nina G. Shah, Steffanie A. Strathdee, David Vlahov, Joel E. Gallant

Research output: Contribution to journalArticlepeer-review

185 Scopus citations


Objective: Studies have shown that HIV-infected injection drug users (IDUs) are less likely to receive antiretroviral therapy than non-drug users. We assess factors associated with initiating highly active antiretroviral therapy (HAART) in HIV-infected IDUs. Methods: A cohort study of IDUs carried out between 1 January 1996 and 30 June 1999 at a community-based study clinic affiliated to the Johns Hopkins University, Baltimore, Maryland. The participants were a total of 528 HIV-infected IDUs eligible for HAART based on CD4+ cell count. The main outcome measure was the time from treatment eligibility to first self-reported HAART use, as defined by the International AIDS Society-USA panel (IAS-USA) guidelines. Results: By 30 June 1999, 58.5% of participants had initiated HAART, most of whom switched from mono- or dual-combination therapy to a HAART regimen. Nearly one-third of treatment-eligible IDUs never received antiretroviral therapy. Cox proportional hazards regression showed that initiating HAART was independently associated with not injecting drugs, methadone treatment among men, having health insurance and a regular source of care, lower CD4+ cell count and a history of antiretroviral therapy. Conclusions: Self-reposed initiation of HAART is steadily increasing among IDUs who are eligible for treatment; however, a large proportion continues to use nonHAART regimens and many remain treatment-naive. Although both groups appear to have lower health care access and utilization, IDUs without a history of antiretroviral therapy use would have more treatment options available to them once they become engaged in HIV care.

Original languageEnglish
Pages (from-to)1707-1715
Number of pages9
Issue number13
StatePublished - 7 Sep 2001


  • Health care access
  • Highly active antiretroviral therapy
  • Injection drug users

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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