Abstract
Adherence to highly active antiretroviral therapy (HAART) regimens remains a challenge for people living with human immunodeficiency virus (HIV). Severe traumas like that of September 11, 2001, can exacerbate the difficulties already associated with adherence. A community-based sample of 68 HIV-seropositive men who have sex with men (MSM) living in New York City who were on protease inhibitor HAART regimens completed quantitative assessments to examine adherence in the aftermath of September 11th. Data were drawn from a larger study of drug use and HIV medication adherence. Assessments conducted from September 24, 2001 to October 24, 2001 were compared to assessments taken 2–4 months prior to September 11th. Repeated measures analyses of variance were used to analyze the number of missed and suboptimal doses (doses taken outside the prescribed time by ±4 hours) reported in the 2 weeks prior to each respective assessment. The results indicated a significant increase in the number of missed doses and the number of suboptimal doses immediately after the events of September 11th. Differences in adherence were not influenced, however, by sociodemographic characteristics. These results suggest that the events of September 11th had an impact on adherence to HIV medications among MSM in New York City and provide further support for the notion that the events of September 11th may have adversely impacted the lives of seropositive individuals. Attention should be paid by clinicians working with HIV-positive individuals on how this event has been incorporated into lives of individuals already burdened by a chronic and demanding disease.
Keywords: Adherence, Drug users, HIV, MSM, Terrorism
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References
- 1.Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents.MMWR Morb Mortal Wkly Rep. 1998; 47(RR-5). Updated as a Living Document on February 4, 2002. Available at: www.hivatis.org. [PubMed]
- 2.Carpenter CCJ, Cooper DA, Fischl MA, Gatell JM, Gazzard BJ, et al. Antiretroviral therapy in adults. Updated recommendations of the International AIDS Society—USA. Panel. JAMA. 2000;283:381–390. doi: 10.1001/jama.283.3.381. [DOI] [PubMed] [Google Scholar]
- 3.Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG Adherence Instruments. AIDS Care. 2000;12:255–266. doi: 10.1080/09540120050042891. [DOI] [PubMed] [Google Scholar]
- 4.Singh N, Squier C, Wagener M, Nguyen MH, Yu VL. Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. Clin Infect Dis. 1999;29:824–830. doi: 10.1086/520443. [DOI] [PubMed] [Google Scholar]
- 5.Halkitis PN, Kirton C. Self-strategies as means of enhancing adherence to HIV antiretroviral therapies: a Rogerain approach. J N Y State Nurses Assoc. 1999;30:22–27. [Google Scholar]
- 6.Stone VE, Adelson-Mitty J, Duefied C, Stager KA, Stein MD, et al. Adherence to protease inhibitor (PI) therapy in clinical practice: usefulness of demographics, attitudes and knowledge as predictors. Poster presented at: 12th World AIDS Conference; June 1998; Geneva, Switzerland.
- 7.Altice FL, Friedland GH. The era of adherence to HIV therapy. Ann Int Med. 1998;129:503–505. doi: 10.7326/0003-4819-129-6-199809150-00015. [DOI] [PubMed] [Google Scholar]
- 8.Ickovics JR, Meisler AW. Adherence in AIDS clinical trials: a framework for clinical research and clinical care. J Clin Epidemiol. 1997;50:385–391. doi: 10.1016/S0895-4356(97)00041-3. [DOI] [PubMed] [Google Scholar]
- 9.Sobell LC, Sobell MB. Timeline Follow-back User's Guide. Toronto, Canada: Alcohol Research Foundation; 1997. [Google Scholar]
- 10.Drug Abuse Screening Test (DAST-10) Toronto, Canada: Addiction Research Foundation; 1982. [Google Scholar]
- 11.Factor SH, Wu Y, Monserrate J, et al. Drug use frequency among street-recruited heroin and cocaine users in Harlem and the Bronx before and after September 11, 2001. J Urban Health. 2002;79:404–408. doi: 10.1093/jurban/79.3.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Friedland GH, Williams A. Attaining higher goals in HIV treatment: the central importance of adherence. AIDS. 1999;13:61–72. [PubMed] [Google Scholar]
- 13.Mayers DL. Drug-resistance HIV-1: the virus strikes back. JAMA. 1998;279:2000–2002. doi: 10.1001/jama.279.24.2000. [DOI] [PubMed] [Google Scholar]
- 14.Richman DD. New strategies to combat HIV drug resistance. Hosp Prac. 1996;15:47–58. doi: 10.1080/21548331.1996.11443331. [DOI] [PubMed] [Google Scholar]
- 15.Vanhove GF, Schapiro JM, Winters MA, Merigan TC, Blaschke TF, et al. Patient compliance and drug failure in protease inhibitor monotherapy. JAMA. 1996;276:1955–1956. doi: 10.1001/jama.276.24.1955. [DOI] [PubMed] [Google Scholar]
- 16.Boucher C. Rational approaches to resistance: using saquinavir. AIDS. 1996;10(suppl 1):S15–S19. [PubMed] [Google Scholar]
- 17.Condra JH, Schleif WA, Blahy OM. In vivo emergence of HIV-1 variants resistant to multiple protease inhibitors. Nature. 1995;374:569–571. doi: 10.1038/374569a0. [DOI] [PubMed] [Google Scholar]
- 18.Ho DD, Neuman AU, Perelson AS, Chen W, Leonard JM, et al. Rapid turnover of plasmavirions and CDH lymphocytes in HIV-1 infection. Nature. 1995;373:123–126. doi: 10.1038/373123a0. [DOI] [PubMed] [Google Scholar]
- 19.Mellors JW. Clinical implications of resistance and cross-resistance to HIV protease inhibitors.Infect Med. 1997;(suppl): 32–38.
- 20.Roland M. Antiviral adherence dilemmas. Focus. 1998;13:1–4. [PubMed] [Google Scholar]
- 21.Schmidt JC, Ruiz L, Clotet B. Resistance-related mutations in the HIV-1 protease gene of patients treated for 1 year with protease inhibitor ritonavir (ABT-538) AIDS. 1996;10:995–999. doi: 10.1097/00002030-199610090-00010. [DOI] [PubMed] [Google Scholar]
- 22.Shafer RW, Winters MA, Palmer S, Merigan T. Multiple concurrent reverse transcriptase and protease and multidrug resistance of HIV-1 isolates from heavily treated patients. Ann Int Med. 1998;128:906–911. doi: 10.7326/0003-4819-128-11-199806010-00008. [DOI] [PubMed] [Google Scholar]
- 23.Tisdale M, Meyers RE, Maschera B, Parry NR, Oliver NM, et al. Cross-resistance analysis of human immunodeficiency virus type 1 variants individually selected for resistance to five different protease inhibitors. Antimicrob Agents Chemother. 1995;39:1704–1710. doi: 10.1128/aac.39.8.1704. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Herman D, Felton C, Susser E. Mental health needs in New York State following the September 11th attacks. J Urban Health. 2002;79:322–331. doi: 10.1093/jurban/79.3.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Galea S, Resnick H, Ahern J, et al. Posttraumatic stress disorder in Manhattan, New York City, after September 11th terrorist attacks. J Urban Health. 2002;79:340–353. doi: 10.1093/jurban/79.3.340. [DOI] [PMC free article] [PubMed] [Google Scholar]