Past heroin use doesn't bar HIV therapy compliance, study finds

By Steve Tokar

HIV-infected people who have used heroin in the past are just as likely to properly take highly active antiretroviral therapy (HAART) and to benefit from the therapy as people who have never used heroin—but are much less likely to be prescribed the therapy. The two findings are the result of a study led by researchers at the San Francisco VA Medical Center.

“People who have kicked heroin are as able as anyone else to comply with the regimen of taking their HIV medicines effectively,” says senior investigator Carl Grunfeld, MD, PhD, chief of the metabolism and endocrine sections at SFVAMC. “Therefore, programs to treat heroin addiction should be part and parcel of HIV treatment programs.

“Because this is an epidemiological study, we do not have the data to say why past heroin users are not as likely to be prescribed HAART at the same rate as other people with HIV,” says Grunfeld, who is also a professor of medicine at the University of California, San Francisco. “We can speculate that physicians might have a tendency to be very wary of people who have used drugs, particularly heroin, and to be more skeptical of their ability to successfully follow a therapeutic drug regimen.”

The study appears in the January 30, 2008 issue of the journal AIDS.

The authors examined current and past drug use among 1,163 HIV-infected patients and 294 HIV-negative control subjects in the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM), a national longitudinal study of HIV-infected people. The average age of the participants was 42; half were non-white and one-third were women. Drug use data was collected through confidential and anonymous self-reporting.

The investigators found that 86 percent of HIV-infected participants and 67 percent of controls had been illicit drug users (marijuana, amphetamine, cocaine, crack cocaine, or heroin) at some time in the past.

Current drug use, most of it marijuana, was 28 percent among HIV-infected participants and 16 percent among controls.

Among HIV-infected participants on HAART, current heroin users and, to a lesser extent, current and past cocaine or crack users were significantly more likely to have detectable HIV. No other current or past drug use was associated with less effective HAART.

Both past and current heroin use were associated with a significantly higher chance of not being on HAART in the first place.

Co-authors of the study are Joseph Cofrancesco, Jr., MD, MPH, of Johns Hopkins School of Medicine; Rebecca Scherzer, PhD, of SFVAMC; Phyllis C. Tien, MD, of SFVAMC and UCSF; Cynthia L. Gilbert, MD, MSc, of George Washington University Medical Center; Heather Southwell, MSc, of the Northern California Institute for Research and Education; Stephen Sidney, MD, MPH, of Kaiser Permanente Medical Care Program; and Adrian Dobs, MD, of JHSM.

The research was funded by grants from the National Institutes of Health, some of which were administered by NCIRE.

NCIRE - the Veterans Health Research Institute - is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.