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AIDS Behav. 2019 Mar;23(3):649-660. doi: 10.1007/s10461-019-02415-w.

The Longitudinal Effects of Non-injection Substance Use on Sustained HIV Viral Load Undetectability Among MSM and Heterosexual Men in Brazil and Thailand: The Role of ART Adherence and Depressive Symptoms (HPTN 063).

Author information

1
Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), 9500 Gilman Drive, MC 0507, La Jolla, San Diego, CA, 92093-0507, USA. ktsuyuki@gmail.com.
2
David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
3
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
4
Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
5
University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
6
Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil.
7
Faculty of Medicine, Chiang Mai University, Muang District, Chiang Mai, Thailand.
8
Research Institute for Health Sciences, Chiang Mai University, Muang District, Chiang Mai, Thailand.
9
Center for Health Equity Research, Brown University, Providence, RI, USA.
10
The Fenway Institute, Fenway Health, Boston, MA, USA.
11
Department of Psychology, University of Miami, Coral Gables, FL, USA.

Abstract

The effect of non-injection substance use on HIV viral load (VL) is understudied in international settings. Data are from HPTN063, a longitudinal observational study of HIV-infected individuals in Brazil, Thailand, and Zambia, with focus on men with VL data (Brazil = 146; Thailand = 159). Generalized linear mixed models (GLMM) assessed whether non-injection substance use (stimulants, cannabis, alcohol, polysubstance) was associated with VL undetectability. ART adherence and depressive symptoms were examined as mediators of the association. In Thailand, substance use was not significantly associated with VL undetectability or ART adherence, but alcohol misuse among MSM was associated with increased odds of depression (AOR = 2.75; 95% CI 1.20, 6.32, p = 0.02). In Brazil, alcohol misuse by MSM was associated with decreased odds of undetectable VL (AOR = 0.34; 95% CI 0.13, 0.92, p = 0.03). Polysubstance use by heterosexual men in Brazil was associated with decreased odds of ART adherence (AOR = 0.25; 95% CI 0.08, 0.78, p = 0.02). VL suppression appears attainable among non-injection substance users. Substance use interventions among HIV-positive men should address depression, adherence, and VL undetectability.

KEYWORDS:

Adherence; Depression; HIV; Substance use; Undetectable viral load

PMID:
30725397
PMCID:
PMC6414080
[Available on 2020-03-01]
DOI:
10.1007/s10461-019-02415-w
[Indexed for MEDLINE]

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