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The interaction of active substance use, depression, and antiretroviral adherence in methadone maintenance

Howard Newville1, Karina M Berg, Jeffrey S Gonzalez

  • 1Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke's, New York, NY, USA, hnewville@chpnet.org.

International Journal of Behavioral Medicine
|August 2, 2014
PubMed

Insights

Substance use impacts highly active antiretroviral therapy (HAART) adherence, especially with lower depression levels. Continued substance use indicates an unmet treatment need in HIV patients on methadone maintenance.

Area of Science:

  • Public Health
  • Clinical Medicine
  • Psychiatry

Background:

  • Adherence to highly active antiretroviral therapy (HAART) is critical for HIV treatment success.
  • Both substance use and depression are linked to HAART nonadherence, but their combined effect is not well understood.
  • Understanding this interaction can improve interventions for adherence, substance use, and depression.

Purpose of the Study:

  • To investigate the interaction between substance use and depressive symptoms on HAART adherence.
  • Focus on patients undergoing methadone maintenance treatment.

Main Methods:

  • Assessed substance use, depressive symptoms, and HAART adherence in 100 HIV-infected individuals on methadone maintenance.
  • Employed regression analysis with an interaction term for substance use and depressive symptoms.
  • Utilized MODPROBE to analyze significant interactions.

Main Results:

  • Illicit substance use was significantly associated with HAART nonadherence (p=0.043).
  • Cannabis use showed the strongest association with nonadherence (p=0.003).
  • A significant interaction effect was observed: illicit substance use predicted nonadherence in individuals with lower depressive symptoms (p=0.007).

Conclusions:

  • Substance use and depressive symptoms interact to affect HAART adherence, but not synergistically.
  • High rates of continued substance use (51%) highlight an unmet need for treatment.
  • Further research into the interplay of substance use and depression on HAART adherence is necessary.
Abstract

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