Current HIV Research, 2012, 10, 000-000 1 1570-162X/12 $58.00+.00 © 2012 Bentham Science Publishers Effectiveness of Antiretroviral Therapy in HIV-1-Infected Active Drug Users Attended in a Drug Abuse Outpatient Treatment Facility Providing a Multidisciplinary Care Strategy Gabriel Vallecillo Sánchez *,1,2 , Josep M. Llibre 3,4 , Marta Torrens 2 , Arantza Sanvisens 4 , Gerard Mateu 2 , Hernando Knobel 1 , Klaus Langohr 5 , Jose R. Santos 3,4 and Roberto Muga 4 1 Departments of Internal Medicine and Drug Addiction Unit of Psychiatry, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain; 2 Drug Addiction Unit of Psychiatry, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain; 3 Lluita contra la SIDA Foundation, Badalona, Spain; 4 Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Spain; 5 Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain, Research programme in neurosciences, IMIM (Hospital del Mar Research Institute), Barcelona, Spain Abstract: Objective: HIV-1-infected active drug users (ADU) obtain smaller clinical benefits with antiretroviral therapy (HAART) compared to non-ADU subjects with sexually-transmitted HIV-1 infection. Therefore treatment strategies are required to address the specific issues arising in this challenging scenario. We describe the effectiveness of HAART provided in a drug abuse outpatient treatment facility through a comprehensive integrated care that includes medical, drug dependence, and psychosocial support. Methods: We included all consecutive HIV-1-infected ADU admitted for drug dependency treatment and who started their first HAART. A comparator arm consisted of a control group of sexually transmitted HIV-1-infected subjects attended in a reference hospital under standard care. The strategy did not include directly observed treatment. Results: A total of 71 ADU and 48 matched subjects infected through sexual transmission were included. ADU had lower baseline CD4+ T-cell counts (196 vs 279 cells/L, P=.001), and more advanced CDC stages (P=.001). The estimated probabilities of patients with virological response (<50 copies/mL) at weeks 48 and 96 were 92.9% (95%-CI: 87.1%—99.1%) and 87.3%% (95%-CI: 78.7%—95.2% for ADU, and 93.7%(95%-CI: 84.1%—99.8%) and 87.5% % (95%-CI: 77.5%—97.3%) for sexually-infected subjects (P= .1325 and .241). Kaplan-Meier estimates of time to loss of virological response did not show differences between groups (log rank test, P=.965). Conclusions: An integrated multidisciplinary care of HIV-1-infected antiretroviral naïve ADU provided in a drug abuse treatment center obtains high rates of virological suppression, similar to those observed in a comparison group of sexually-transmitted HIV-1-infected subjects. This strategy should be further evaluated in public health programs and assessed in randomized trials. Keywords: Active drug users, HAART, antiretroviral effectiveness, treatment adherence, multidisciplinary care. INTRODUCTION Despite the availability of highly active antiretroviral therapy (HAART), data show the persistence of a significant difference in treatment outcomes between HIV-1 infected drug users and non-drug user subjects [1-3]. HIV-1-infected drug users start treatment significantly later, have poorer long-term adherence to HAART, achieve lower rates of virological suppression, and experience a more rapid disease progression with higher mortality rates (both HIV-1 related or not) than HIV-1-infected non–drug users [1-5]. Furthermore, non-active drug users are routinely underrepresented in most antiretroviral treatment trials, while active drug users (ADU) are routinely excluded [1-3]. HIV-1-infected drug users commonly exhibit several comorbidities (nutritional deficiencies, soft-tissue infections, *Address correspondence to this author at the Department of Internal Medicine, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain; Tel: +0034932483251; E-mail: 91773@parcdesalutmar.cat hepatitis C co-infection, tuberculosis) and specific social issues (poverty, marginalization, homelessness, legal problems) that may jeopardize their compliance with HAART. The optimal management of these issues is crucial to enhance HAART outcomes in HIV-1-infected ADU and indicates the need for specially designed ancillary services [1-3]. Nevertheless, services for multiple medical and psychosocial problems faced by HIV-1-infected ADU are often provided by a range of health care professionals, who are often located in different settings, not necessarily interconnected. This fragmentation of care can lead to poorer treatment adherence, limited follow-up, increased risk for treatment interruption, and poorer clinical outcomes [6]. Hence, integrated models of care could facilitate HAART success in this setting. An active substance use disorder and HIV-1 infection are interacting chronic diseases, and one of the strategies developed to improve outcomes in these subjects is combining antiretroviral therapy with substance abuse treatment. Methadone maintenance treatment has been associated with improved uptake of treatments, adherence,