Robin M Nance1, Maria Esther Perez Trejo1, Bridget M Whitney1, Joseph A C Delaney1, Fredrick L Altice2, Curt G Beckwith3, Geetanjali Chander4, Redonna Chandler5, Katerina Christopoulous6, Chinazo Cunningham7, William E Cunningham8, Carlos Del Rio9, Dennis Donovan10, Joseph J Eron11, Rob J Fredericksen12, Shoshana Kahana5, Mari M Kitahata12, Richard Kronmal1, Irene Kuo13, Ann Kurth14, W Chris Mathews15, Kenneth H Mayer16, Richard D Moore17, Michael J Mugavero18, Lawrence J Ouellet19, Vu M Quan20, Michael S Saag18, Jane M Simoni21, Sandra Springer2, Lauren Strand1, Faye Taxman22, Jeremy D Young19, Heidi M Crane12. 1. Department of Biostatistics, University of Washington, Collaborative Health Studies Coordinating Center, Seattle. 2. Department of Medicine, Yale University School of Medicine, New Haven, Connecticut. 3. Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island. 4. Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland. 5. National Institute on Drug Abuse, Bethesda, Maryland. 6. Department of Medicine, University of California-San Francisco. 7. Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York. 8. Department of Medicine, University of California-Los Angeles. 9. Department of Global Health, Emory University, Atlanta, Georgia. 10. Department of Psychiatry, University of Washington, Seattle. 11. Department of Medicine, University of North Carolina, Chapel Hill. 12. Department of Medicine, University of Washington, Seattle. 13. Department of Epidemiology, George Washington University, Washington, DC. 14. School of Nursing, Yale University School of Medicine, New Haven, Connecticut. 15. Department of Medicine, University of California-San Diego, UCSD Medical Center. 16. Harvard Medical School, Fenway Institute, Boston, Maryland. 17. Department of Medicine, Johns Hopkins University, Baltimore, Maryland. 18. Department of Medicine, University of Alabama-Birmingham. 19. University of Illinois-Chicago. 20. Centers for Disease Control and Prevention, Atlanta, Georgia. 21. Department of Psychology, University of Washington, Seattle. 22. Department of Criminology, George Mason University, Fairfax, Virginia.
Abstract
BACKGROUND: Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. METHODS: This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. RESULTS: The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4-2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). CONCLUSIONS: Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.
BACKGROUND: Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. METHODS: This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. RESULTS: The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4-2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). CONCLUSIONS: Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.
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