***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To identify the effects of substance abuse status ( active , former , and never ) on utilization of highly active antiretroviral therapy ( HAART ) , medication adherence , and virologic and immunologic responses to therapy . Design : Prospect i ve cohort study of 764 HIV‐1‐infected patients who attended an urban HIV clinic and participated in a st and ardized interview .  Main Outcome Measures : Past utilization of HAART , self‐reported nonadherence with antiretroviral therapy  , and changes in HIV‐1 RNA level and CD4 + lymphocyte count relative to prior peak and nadir , respectively . Results : Forty‐four percent of active drug users failed to utilize HAART compared with 22 % of former drug users and 18 % of non‐drug users ( p < .001 for both comparisons ) . Among participants who were taking antiretroviral therapy when interviewed , active drug users were more likely to report medication nonadherence ( 34 % vs. 24 % of nonusers and 17 % of former users ) , had a smaller median reduction in HIV‐1 RNA from baseline ( 0.8 log10 copies/ml vs. 1.7 in nonusers and 1.6 in former users ) , and had smaller median increases in CD4 + lymphocyte count from baseline ( 65 cells/mm3 vs. 116 in nonusers and 122 in former users ) ( p < .05 for all comparisons with active users ) . Conclusions : Active drug use was strongly associated with underutilization of HAART , nonadherence , and inferior virologic and immunologic responses to therapy , whereas former drug users and non‐drug users were similar in all outcomes . Effective strategies are needed that integrate HIV‐1 and substance abuse treatments Directly administered antiretroviral therapy ( DAART ) is one approach to improving adherence to among human immunodeficiency virus (HIV)-infected drug users . We evaluated the essential features of a community-based DAART intervention in a r and omized , controlled trial of DAART versus self-administered therapy .  Of the initial 72 subjects , 78 % were racial minorities , and 32 % were women . Social and medical comorbidities among subjects included homelessness ( 35 % of subjects ) , lack of interpersonal support ( 86 % ) , major depression ( 57 % ) , and alcoholism ( 36 % ) . At baseline , the median CD4 + cell count was 403 cells/mL and the median HIV-1 RNA load was 146,333 copies/mL ( log10 5.31 copies/mL ) . During the prior 6 months , 33 % of subjects had missed a medical appointment , and 47 % had visited an emergency department . Although most subjects ( 67 % ) preferred to take their own medications , 76 % would accept DAART if it were made compulsory . A methadone clinic was the DAART venue acceptable to the fewest subjects ( 36 % ) , and a mobile syringe-exchange program was acceptable to the most subjects ( 83 % ) . Adherence was higher for supervised than for unsupervised medication administration ( P<.0001 ) , a finding that supports use of daily supervision of once-daily regimens . Moreover , DAART should incorporate enhanced elements such as convenience , flexibility , confidentiality , cues and reminders , responsive pharmacy and medical services , and specialized training for staff To evaluate the impact of  injection drug users ( IDUs ) adherence on effectiveness of highly active antiretroviral therapy ( HAART ) , repeated measures of plasma viral load and CD4 + counts before HAART initiation and at last visit in the cohort were studied . Data were collected by means of patient 's face-to-face and self-administered question naires about adherence to HAART during the week prior to the last visit . Of a total of 119 patients treated with HAART , undetectable viral load was obtained for 55 patients ( 46.2 % ) ( G3 ) ; 34 patients ( 28.6 % ) ( G2 ) had a viral load decline > 0.5 log copies/ml but still detectable viral load at last visit in the cohort , while 30 patients ( 25.2 % ) ( G1 ) had no decline or decline ≤ 0.5 log copies/ml . Proportion of 100 % adherent patients was significantly higher in G3 ( 83.6 % ) than in G2 ( 64.7 % ) and G1 ( 56.7 % ) . In spite of differences in virological success and adherence , mean increase in CD4 + counts was similar in G3 ( 123 ± 160 counts/mm3 ) and G2 ( 143 ± 147 ) while no immunological improvement was observed in G1 . For the sub-groups of patients whose limited adherence has implied virological failure but did not impede short-term immunological reconstitution following HAART initiation , decision to switch HAART regimens could be delayed until interventions for improving future adherence have been carried out Objective To assess the temporal association of changes in substance abuse with  antiretroviral therapy use and adherence , HIV-1 RNA suppression , and CD4 cell count changes in patients attending an urban clinic . Design Prospect i ve cohort study . Methods Six-hundred and ninety-five HIV-1-infected individuals , who completed two or more semi-annual st and ardized surveys and in whom antiretroviral therapy was indicated , were included in the analysis . Surveys addressed antiretroviral therapy  use and adherence , and use of illicit drugs and alcohol . Substance abuse was defined as active heroin , cocaine , or heavy alcohol use in the 6 months preceding survey . The units of analysis were consecutive pairs of surveys ( couplets ) in individual participants . Couplets in which participants denied substance abuse in both surveys were compared to couplets in which participants switched from non-use to substance abuse , and couplets in which participants reported substance abuse in both surveys were compared to couplets where participants switched from substance abuse to non-use . Results Switching from non-use to substance abuse was strongly associated with worsening antiretroviral therapy use and adherence , less frequent HIV-1 RNA suppression , and blunted CD4 cell increases , compared to remaining free of substance abuse . Alternatively , switching from substance abuse to non-use was strongly associated with improvements in antiretroviral therapy use and adherence , and HIV-1 treatment outcomes , compared to persisting with substance abuse . Conclusions This longitudinal study highlights the dynamic nature of substance abuse and its temporal association with the effectiveness of  HIV-1 treatment in patients attending an inner-city clinic This study assesses changes in quality of life ( QoL ) over time among HIV-infected individuals receiving antiretroviral therapy ( ART )  and evaluates how this relates to ART adherence . Prospect i ve , longitudinal data were examined from 1050 participants in two large , r and omized , multi-centre antiretroviral clinical trials .  QoL was assessed by the SF-12 ; adherence by the Terry Beirn Community Programs for Clinical Research on AIDS Antiretroviral Medication Self-report .  Participants included 20 % women , 53 % African Americans , 16 % Latinos ; mean age was 39 years ; mean baseline CD4 + cell count 230 cells/mm3 ; 89 % were ART-naïve at entry .  Baseline physical and mental health summary QoL scores were 45.4 and 42.9 , comparable to scores reported in other advanced HIV population s. Significant improvements in mean QoL scores were seen for the group as a whole after 1 to 4 months on new ART regimens , and persisted for 12 months . Participants reporting 100 % ART adherence achieved significantly higher QoL scores at 12 months compared to those with poorer adherence , particularly if 100 % adherence was consistent ( p<0.001 ) . Those with at least 80 % ART adherence had smaller gains in QoL at 12 months when compared to baseline , while those with < 80 % adherence had worsening of QoL. In this analysis , ART adherence was associated with improved QoL , particularly if adherence was sustained Improved therapeutic strategies , including the introduction of protease inhibitors , have led to a striking decrease in HIV-related morbidity and mortality ( 1 , 2 ) . It is widely believed that adherence to an antiretroviral regimen is central to the likelihood that a patient will derive sustained benefit from therapy ( 3 , 4 ) . Conventional wisdom holds that two groups of patients are currently experiencing clinical and virologic failure . The first group consists of patients who have received multiple different antiretroviral drugs over a prolonged period of time and who may be infected predominantly with HIV strains that are resistant to multiple drugs . The second group comprises patients who adhere poorly to their antiretroviral regimen .  The two groups are not mutually exclusive : Patients with suboptimal adherence may be more likely to have antiretroviral drugresistant HIV infection . The potential public health importance of adherence to therapy in prevention of transmission of drug-resistant virus has also been emphasized ( 5 ) . Patients with suboptimal adherence to antiretroviral therapy and poor adherence to use of safer-sex practice s , such as use of condoms , may infect others with their own antiretroviral drugresistant virus . Anecdotal experience suggests that physicians may be unwilling to prescribe combination antiretroviral therapy to patients whom they perceive to be at high risk for poor adherence ( 6 ) . Given the critical importance of adherence to therapy to patient outcome , secondary prevention of HIV infection , and willingness of providers to prescribe therapy , we prospect ively investigated the association between protease inhibitor adherence and patient outcome , factors related to adherence , and the accuracy of physicians ' prediction of patient adherence . We used a microelectronic monitoring system to assess adherence to antiretroviral therapy . Methods Study Sample The study was conducted at the HIV clinics of the Veterans Affairs Medical Center , Pittsburgh , Pennsylvania , and University of Nebraska Medical Center , Omaha , Nebraska . The HIV physicians at these clinics were primary care providers for the study patients . Each site also had a dedicated HIV nurse coordinator . From August 1997 to March 1999 , we enrolled consecutive patients with HIV infection who were already receiving a protease inhibitor ( experienced patients ) or who were to begin taking a protease inhibitor ( naive patients ) . Exclusion criteria were inability to give informed written consent ; expectation of continued use of a medication organizer to include protease inhibitors ; and residence in a nursing home , jail , or hospice , where medications were dispensed at least daily . Collection of Baseline Data At baseline , a study investigator used medical chart review to complete a 52-item question naire for each patient . The question naire covered demographic information ( age , sex , ethnicity , risk factors for HIV infection , educational and employment status , income ) , medical history ( years known to be HIV infected ; opportunistic infections ; history of schizophrenia , depression , or bipolar affective disorder ) , and medication use ( name , dose , and frequency of all antiretroviral agents , other antimicrobials , and other prescription therapies ) . The enrolling physician assessed use of illegal drugs and nonprescription therapies ( including herbal or alternative therapies ) by interview . Alcohol abuse was assessed by using the CAGE question naire ( cutting down , annoyance with criticism , guilty feelings , and use of eye-opener drinks ) ( 7 ) . Information about use of adherence aids ( such as personal reminders by significant others or timers , alarms , or other devices ) was specifically sought . The investigator asked study patients if they felt that their current symptoms were attributable to HIV infection , the antiretroviral medications , or both . In addition , patients were asked whether they agreed with such health beliefs as Do you think your antiretroviral therapy will make you live longer ? At baseline , each patient completed the Beck Depression Inventory  and the  General Health Question  naire ( 8 , 9 ) , well-vali date d measures of psychiatric morbidity that have been widely used in patients with HIV infection ( 9 - 11 ) . Patients completed the inventories as a written task without the assistance of a physician or clinic nurse . At baseline , we used the following question to elicit a prediction of adherence to protease inhibitor therapy from the patient 's primary HIV physician and clinic nurse : Do you think that the patient is compliant with antiretroviral therapy , that is , taking greater than 80 % of the prescribed doses of antiretroviral medications ? This prediction was made after collection of the baseline information but before actual measurement of adherence using the microelectronic monitoring system had begun . Collection of Follow-up Data Every 3 months for the duration of the study , the study participants were asked whether any of the following had changed since their previous visit : employment , use of alcohol or illegal drugs , residence , attribution of symptoms to the antiretroviral therapy or HIV infection , and changes in medications . Patients completed a new Beck Depression Inventory and General Health Question naire . The primary HIV physician determined whether the patient had developed an opportunistic infection in the past 3 months . Laboratory Testing At baseline and every 3 months for the duration of the study , HIV RNA levels were measured by using the Roche Amplicor System ( Roche Diagnostics , Nutley , New Jersey ) and CD4 lymphocyte sub population assays were performed . Assessment of Ad 
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Overall , active substance use was associated with poor adherence , as well as depression and low social support .
Higher adherence was found in patents receiving care in structured setting s ( e.g. directly observed therapy ) and /or drug addiction treatment ( especially substitution therapy ) .
While lower than other population s-especially among users of stimulants , incarcerated DU and patients with psychiatric comorbidities-adherence to HAART among HIV-positive DU can be achieved .
Better adherence was identified among those engaged in comprehensive services providing HIV and addiction treatment with psychosocial support