Substance use and depression among patients adherent and non-adherent to antiretroviral therapy

The aim of the study was to determine the main predictors of leaving antiretroviral therapy by HIV-infected patients. We retrospectively assessed depression, hopelessness, substance use, viral load, and CD4+ counts of 120 patients who dropped out of antiretroviral therapy for ≥12 months (Lost-to-Care) and 120 who continued for ≥12 months (Engaged-in-Care). As expected, lost-to-care patients had higher viral load and, accordingly, fewer CD4+ lymphocytes. The level of depression, alcohol consumption, and injecting drug use in the 30 days preceding analysis was significantly higher in Lost-to-Care than in Engaged-in-Care HIV-infected patients. A binary logistic regression [χ2(4) = 64.27, p = 0.000] correctly classified 74.5% of participants as Lost-to-Care or Engaged-in-Care. The results indicate that substance use and depression are associated with antiretroviral therapy dropout. Evaluation of these factors with high degree of accuracy can predict patient’s antiretroviral therapy adherence. An integrated treatment for substance use and psychiatric disorders in HIV infected patients could reduce antiretroviral therapy dropout and improve outcomes of HIV treatment in Russia.