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Doug S Saunders1, William J Lancee2, Sean B Rourke3

1University of Toronto, 2Mount Sinai Hospital, 3St Michaelís Hospital, Toronto, Ontario

Objective: To understand the contradictory evidence about the relationship between alcohol or drug use and poor adherence to HAART medication. The Identification of Necessary Factors for Medication Management of HAART (INFORMM-HAART) project is a longitudinal natural history study with a 9-month monitoring period.

Methods: Baseline data from the first 78 subjects participating in the study were analyzed. None, moderate, and heavy use levels were defined for alcohol and recreational drugs, separately. Subjects were designated as: (a) heavy users of either alcohol or recreational drugs; (b) non-users; and (c) the remaining as moderate users. Interpersonal and psychological problems with alcohol and drug use were also assessed and investigated as a potential explanatory variable.

Results: 10% of the subjects missed at least 15% of doses prescribed over an 8-week period (85% or less adherence). 70% of the subjects did not miss more than 5% of prescribed doses (95% or greater adherence). The remaining 20% of subjects had between 85% and 95% adherence. Overall there were no differences in adherence rates for the three levels of use. However, among the moderate users, subjects with interpersonal and psychological difficulties related to substance use had a significantly lower adherence rate than other moderate users (44% versus 88% had optimal adherence, P<0.01). Paradoxically, the 19 heavy users reported few adherence problems, a result that may be related to reporting bias.

Conclusion: Alcohol and recreational drug use per se does not appear to be related to adherence problems. Rather, subjects in the study who experienced alcohol and drug related interpersonal and psychological problems had less than optimal adherence to HAART medication. Adherence difficulties among moderate users may be mediated through psychological difficulties.