HIV-infected individuals who use alcohol and other drugs, and virologic suppression

Abstract

People living with HIV (PLWH) on antiretroviral therapy (ART) who use substances were examined to (a) describe those with virologic control and (b) determine which substance use-factors are associated with lack of virologic control. Participants were adult PLWH taking ART with either past 12-month DSM-IV substance dependence or past 30-day alcohol or illicit drug use. Substance use factors included number of DSM-IV alcohol or drug dependence criteria and past 30-day specific substance use. Associations with HIV viral load (HVL) (<200 vs. ≥200 copies/mL) were tested using logistic regression models. Multivariable analyses adjusted for age, sex, homelessness and anxiety or depression. Participants (n = 202) were median age 50 years, 66% male, 51% African American and 75% self-reported ≥90% past 30-day ART adherence. Though HVL suppression (HVL <200 copies/mL) was achieved in 78% (158/202), past 30-day substance use was common among this group: 77% cigarette use; 51% heavy alcohol use; 50% marijuana; 27% cocaine; 16% heroin; and 15% illicit prescription opioid use. After adjusting for covariates, specific substance use was not associated with a detectable HVL, however number of past 12-month DSM-IV drug dependence criteria was (adjusted odds ratio = 1.23 for each additional criterion, 95% CI: 1.04–1.46). Three-quarters of a substance-using cohort of PLWH receiving ART had virologic control and ≥90% ART adherence. Substance dependence criteria (particularly drug dependence), not specifically substance use, were associated with lack of virologic control. Optimal HIV outcomes can be achieved by individuals who use alcohol or drugs and addressing symptoms of substance dependence may improve HIV-related outcomes.

Substance Use and Adherence to Antiretroviral Therapy: What Is Known and What Is Unknown

“…Of note, in many of these same studies [24, 26, 27, 25], cannabis use was not a risk for suboptimal ART adherence. This lack of association between cannabis use and ART adherence was also documented in other recent analyses [30–32].…”

“…A recent review examining the impacts of alcohol on the HIV cascade of care continuum published between 2010 and 2015 found an association between alcohol use and nonadherence, usually in a dose-response fashion, in most (n=16) of the 33 included studies focusing on the ART adherence step [22]. Other recent studies confirm this negative influence of alcohol on ART adherence in a variety of contexts [23, 17, 24, 25]. …”

“…Recent research conducted in North America [24, 26–29] also confirms the links between heroin and cocaine use and suboptimal ART adherence found in previous reviews [14]. For example, a large study that pooled data from over 1,500 PLHIV across different sites in the United States, found independent and strong negative associations between recent heroin or cocaine use and objective measures of ART adherence (i.e., using electronic data monitoring) [27].…”

Sex Trade and Health Care Utilization Among People Living with HIV/AIDS

“…These findings highlight the need for more attention to those who trade sex and use drugs. In the absence of treatment, research has shown that alcohol and substance use has a negative effect on ART adherence and subsequent viral suppression, emphasizing likely consequences of not utilizing substance use treatment among PLWH engaged in sex trade [70]. …”

Drug Use and Abuse in HIV

“…Additionally, HIV-infected and HIV/hepatitis c virus-coinfected patients in opiate replacement therapy require higher methadone dose [20]. Among drug users, the analysis of HIV infection and prevention presents a relationship between drug-use and men-who-have-sex with other men, sexual behavior and sexually-transmitted diseases [21][22][23].…”