Prevalence of and Risk Factors for Substance Use Among Perinatally Human Immunodeficiency Virus–Infected and Perinatally Exposed but Uninfected Youth

Abstract

Purpose This study examines risk factors associated with recent substance use (SU) among perinatally HIV-infected (PHIV+) and perinatally exposed, uninfected (PHEU) youth and compares SU lifetime prevalence with the general population of United States (US) adolescents. Methods We conducted cross-sectional and longitudinal analyses of 511 PHIV+ and PHEU youth (mean age at study entry 13.2 years, 51% female, 69% PHIV+, 72% African American) enrolled in a US multi-site prospective cohort study between 2007–2009. SU data were collected by audio computer-assisted self interview. Youth Risk Behavior Surveillance System and Monitoring the Future data were used to compare SU lifetime prevalence to US samples. Results Perinatal HIV infection was not a statistically significant risk factor for alcohol or marijuana use. Risk factors for alcohol use among PHIV+ youth included higher severity of emotional and conduct problems and alcohol and marijuana use in the home by the caregiver/others. Risk factors for marijuana use among PHIV+ youth included marijuana use in the home, higher severity of conduct problems, and stressful life events. Similar SU risk factors among PHEU youth included SU in the home and higher severity of conduct and emotional problems. Overall lifetime prevalence of SU by age was similar to that in national surveys. Conclusions Although SU lifetime prevalence and risk factors for PHIV+ and PHEU adolescents were similar to national norms, the negative consequences are potentially greater for PHIV+ youth. Prevention efforts should begin before SU initiation and address the family and social environment and youth mental health status.

Elevated Aspartate Aminotransferase-to-Platelet Ratio Index in Perinatally HIV-Infected Children in the United States

“…The 0.8% prevalence of APRI > 1.5 in this pediatric cohort appears lower than rates of 3.0–3.9% reported in several studies of HIV-infected adults [7–9] and much lower than the 8% rate observed in one adult study [10]. This lower prevalence among HIV-infected children is likely attributable to lower rates in HIV-infected children compared to HIV-infected adults of other factors that contribute to liver problems, such as viral hepatitis and alcohol use (only 36% of perinatal HIV AMP participants reported alcohol use [11]). The prevalence of APRI > 1.5 in this US pediatric cohort is also substantially lower than the 3.2% prevalence reported in a large group of children in Latin America [12].…”

Profiles of Risk Among HIV-Infected Youth in Clinic Settings

“…There is evidence that some perinatally-infected youth engage in unprotected sex and have multiple partners not all of whom are seroconcordant [40]. Furthermore, substance use, which can potentiate sexual risk behaviors, occurs at levels comparable to the general population as perinatally-infected youth grow older [41]. Many perinatally-infected youth have significant mental health needs [42].…”

Changes in Substance Use Symptoms Across Adolescence in Youth Perinatally Infected with HIV

“…Only a few studies have examined the prevalence and correlates of substance use among PHIV+ youths with studies reporting rates of any or lifetime substance use ranging from 13–60 % [7, 11, 19, 20]. Our current understanding of problematic substance use among PHI-V+ youths is limited because substance use typically begins to take off in middle-older adolescence and PHI-V+ youths are only now reaching this age in large enough numbers to be studied.…”

“…perceived peer norms) and contextual (e.g. caregiver psychiatric disorder, substance use in the household) factors appear to confer greater risk [7, 11, 19, 20]. However, these studies were largely cross-sectional and focused on mostly younger adolescence, when rates of problematic substance use and disorder are typically low [22, 23].…”