Context.— In British Columbia, human immunodeficiency virus (HIV)–infected
persons eligible for antiretroviral therapy may receive it free but the extent
to which HIV-infected injection drug users access it is unknown.
Objective.— To identify patient and physician characteristics associated with antiretroviral
therapy utilization in HIV-infected injection drug users.
Design.— Prospective cohort study with record linkage between survey data and
data from a provincial HIV/AIDS (acquired immunodeficiency syndrome) drug
Setting.— British Columbia, where antiretroviral therapies are offered free to
all persons with HIV infection with CD4 cell counts less than 0.50×109/L (500/µL) and/or HIV-1 RNA levels higher than 5000 copies/mL.
Subjects.— A total of 177 HIV-infected injection drug users eligible for antiretroviral
therapy, recruited through the prospective cohort study since May 1996.
Main Outcome Measures.— Patient use of antiretroviral drugs through the provincial drug treatment
program and physician experience treating HIV infection.
Results.— After a median of 11 months after first eligibility, only 71 (40%) of
177 patients had received any antiretroviral drugs, primarily double combinations
(47/71 [66%]). Both patient and physician characteristics were associated
with use of antiretroviral drugs. After adjusting for CD4 cell count and HIV-1
RNA level at eligibility, odds of not receiving antiretrovirals were increased
more than 2-fold for females (odds ratio [OR], 2.53; 95% confidence interval
[CI], 1.08-5.93) and 3-fold for those not currently enrolled in drug or alcohol
treatment programs (OR, 3.49; 95% CI, 1.45-8.40). Younger drug users were
less likely to receive therapy (OR, 0.47/10-y increase; 95% CI, 0.28-0.80).
Those with physicians having the least experience treating persons with HIV
infection were more than 5 times less likely to receive therapy (OR, 5.55;
95% CI, 2.49-12.37).
Conclusions.— Despite free antiretroviral therapy, many HIV-infected injection drug
users are not receiving it. Public health efforts should target younger and
female drug users, and physicians with less experience treating HIV infection.