Active cocaine use is associated with lack of HIV-1 virologic suppression independent of nonadherence to antiretroviral therapy: Use of a rapid screening tool during routine clinic visits

Abstract

Clarifying the relationship between illicit drug use and HIV-1 virologic suppression requires characterization of both illicit drug use activity and adherence to antiretroviral therapy (ART). We developed a rapid clinical questionnaire to assess prior 7-day illicit drug use and ART adherence in a cross-sectional study among 1,777 HIV-infected persons in care. Of these, 76% were male, 35% were African-American, and 8% reported injection drug use as their probable route of HIV-1 infection. Questionnaire-reported frequencies of cocaine and marijuana use within the previous 7 days were 3.3% and 12.1%, respectively. Over three quarters (77.8%) of participants were on ART, of whom 69.7% had HIV-1 virologic suppression (HIV-1 RNA<48 copies/mL). Univariate analyses revealed that compared to no use, cocaine and marijuana use were both associated with missed ART doses (P<0.01). Multivariable logistic regression analysis adjusting for non-adherence demonstrated that cocaine use was independently associated with failing to achieve virologic suppression (adjusted odds ratio (aOR), 0.46; 95% confidence interval (CI), 0.22–0.98) but marijuana use was not (aOR, 1.08; 95% CI, 0.72–1.62). This result strengthens the evidence of a direct effect of cocaine on virologic control, independent of non-adherence to ART.

Viral Suppression and Antiretroviral Medication Adherence Among Alcohol Using HIV-Positive Adults

“…Similar to recent reports, (33) we observed an association between cocaine use and unsustained viral suppression in bivariate analysis. One likely mechanism accounting for cocaine’s influence on HIV replication is a downregulation effect of cocaine on micro-RNA in CD4 cells, referred to as cocaine induced enhancement of HIV replication.…”

Health Literacy and Demographic Disparities in HIV Care Continuum Outcomes

“…For the purposes of this study, ART adherence was assessed among those receiving ART during the year and was categorized as “None missed” if the answer was 0 and “Any missed” if the answer was ≥ 1. This coding was consistent with prior work published in this cohort [35] and maximized the contrast between maximally adherent patients and their comparator group. To simplify interpretation of relative risks (RRs) in regression modeling, with values > 1 implying adverse associations and < 1 implying protective associations, outcomes were coded in the negative; that is, the regression outcomes were properly lack of ART adherence, lack of retention in care, and lack of viral suppression.…”

“…Antiretroviral adherence was measured using a brief questionnaire [35] modified from previously validated questionnaires [36, 37]. Using consecutive sampling at routine clinic visits, with the questionnaire administered once per patient per visit, patients were first asked, “Are you on antiretroviral therapy (ART)?” and secondly, “In the past week (7 days), how many times have you missed it?” Responses to the first question were recorded in the electronic health record categorically as “yes” or “no”.…”

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

“…The Rapid Screening Tool (RST) is a short, self-reported questionnaire that evaluates the frequency of substance use and the number of missed cART doses in a 7-day recall period. It has been used by CCASAnet and Vanderbilt researchers and shown to correlate well with other measures (19) and was translated and back-translated by local research staff into Spanish or Portuguese. Clinic staff administered the questionnaire at patient visits.…”