Background:  Despite the availability and effectiveness of ART, HIV⁺ patients may find ART difficult to take as prescribed, and some take “drug holidays.” However, drug holidays may contribute to virologic failure to ART, development of drug resistance, and HIV disease progression. We describe risk factors associated with, and reasons for, taking drug holidays.
Methods:  We used 2000-2004 data from the Supplement to HIV/AIDS Surveillance project, a cross-sectional interview study of HIV⁺ persons ≥18 years conducted in 18 states. We limited the analysis to persons who reported having a current ART prescription. We used multivariable logistic regression, controlling for CD4 count and viral load, to describe characteristics associated with drug holidays (no ART doses for ≥2 days) in the year prior to interview.
Results:  Of 6129 subjects, 1424 (23%) reported taking drug holidays. Compared with persons who always took ART as prescribed, persons who took drug holidays were more likely to rarely (adjusted odds ratio [aOR] 14.1, 95% confidence interval [CI] 9.5 to 21.0) or only sometimes (aOR 7.9, 95%CI 6.2 to 10.1) take ART as prescribed in the past 30 days. Compared with those who were prescribed only 1 pill daily, persons who took drug holidays were more likely to be prescribed ≥4 pills daily (aOR 1.4, 95%CI 1.0 to 1.8). Taking drug holidays was also associated with reporting illicit drug use in the year before interview (aOR 1.6, 95%CI 1.4 to 1.9) and risk for alcoholism as measured by the CAGE questions (aOR 1.2, 95%CI 1.1 to 1.8). Taking drug holidays was more common among men who have sex with men and who injected drugs compared to heterosexuals (aOR 1.6, 95%CI 1.3 to 2.1), but was not associated with race/ethnicity, age, sex, or employment status. The most common reasons for taking drug holidays were side effects to ART (17%), being “tired of taking” ART (17%), running out of medicines (15%), and on the advice of a physician (14%).
Conclusions:  Nearly 1 in 4 respondents surveyed had taken a drug holiday in the past year, and most drug holidays were not recommended by physicians. Physicians should be aware that patients with certain characteristics—illicit drug use, heavy alcohol use, HIV acquisition risk of male–male sex and injection drug use, high pill burden, and poor adherence to ART—are more likely to take drug holidays. By asking about and addressing side effects and ensuring mechanisms for patients to obtain short-term supplies of ART when they run out, some drug holidays may be prevented.