Brief Report: Cocaine Use and Pre-exposure Prophylaxis: Adherence, Care Engagement, and Kidney Function

Abstract

Background: Concomitant use of cocaine and HIV pre-exposure prophylaxis (PrEP) raises important clinical questions around adherence, retention in care, and renal toxicity. Methods: We assessed the associations of confirmed cocaine use with PrEP adherence (both ascertained via objective measures), care engagement, and renal function in the iPrEx open label extension. Cocaine use was measured in scalp hair samples and categorized as: light (500-3,000 pg/mg) and moderate to heavy (>3,000 pg/mg). PrEP adherence in the first three months was measured via plasma tenofovir concentrations. Disengagement from PrEP care was defined as a gap in follow-up greater than four months. Serum creatinine was assessed at baseline and quarterly visits. Results: Of the 400 participants included in this analysis, 90% were men who have sex with men, 10% transgender women, 74% Hispanic/Latino; 21% tested positive for cocaine use in the last three months. In adjusted analysis, light cocaine use (aOR 2.10 [95% CI 1.07-4.14]) and moderate to heavy use (aOR 2.32 [1.08-5.00]) were associated with greater odds of having plasma tenofovir concentrations below the level of quantitation. Participants with moderate to heavy use

Alcohol consumption, substance use, and depression in relation to HIV Pre-Exposure Prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men

“…With respect to substances, consistent with previous research (e.g., [ 42 ]), moderate/high risk cocaine use was significantly associated with PrEP nonadherence. Consuming cocaine at elevated levels may be linked to impaired neurocognitive functioning and pronounced lifestyle disruptions [ 59 ]; both of which can diminish the likelihood of following one’s PrEP regimen as prescribed.…”

“…Within the context of PrEP treatment, substance use and depression on their own have been linked to PrEP nonadherence, but similar to alcohol, disparate findings have been yielded. Specifically, nonadherence has been significantly associated with the use of some types or classes of substances (e.g., stimulants, club drugs) but not others (e.g., cannabis) [36,37,[41][42][43][44]; and the presence of depressive symptomatology has been associated with both an increased and decreased likelihood of PrEP nonadherence among gbMSM [45].…”

Characterization of HIV Preexposure Prophylaxis Use Behaviors and HIV Incidence Among US Adults in an Integrated Health Care System

“…We evaluated alcohol and SUD as clinical risk factors, as these are well-established risk factors of poor adherence and care engagement in the PrEP and HIV treatment literature. 21 , 22 , 23 Insurance type and NDI were missing in less than 0.5% of all participants and were handled using listwise deletion. Incident HIV diagnoses were identified using a KPNC HIV registry.…”

An update on drug–drug interactions between antiretroviral therapies and drugs of abuse in HIV systems

“…A single-center study based in Vancouver, Canada, found that daily crack cocaine use to adversely impact optimal pharmacy refill adherence in one prospective study [114], while another study based in Boston, MA, found heavy cocaine use to be associated with lower rates of self-reported ART adherence [115]. This finding is consistent for HIV uninfected individuals on pre-exposure prophylaxis (PrEP) as well, with lower rates of adherence among persons using cocaine or stimulants [116] [117]. Not only does cocaine use appear to decrease rates of ART adherence, multiple studies have also shown heavy use to decrease rates of viral suppression, [118] [119], highlighting the public health impact of cocaine use among PLWHA.…”