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AIDS Care. 2017 Sep;29(9):1129-1136. doi: 10.1080/09540121.2017.1327646. Epub 2017 May 17.

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

Author information

1
a Department of Medicine , University of British Columbia, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.
2
b Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA.
3
c Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA.
4
d Data Coordinating Center , Boston University School of Public Health , Boston , MA , USA.
5
e Section of Infectious Diseases, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA.
6
f Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA.

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.

KEYWORDS:

HIV; antiretroviral; injection drug use; medication adherence; substance use

PMID:
28513200
PMCID:
PMC5543330
DOI:
10.1080/09540121.2017.1327646
[Indexed for MEDLINE]
Free PMC Article

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