TY - JOUR
T1 - Impact of abstinence and of reducing illicit drug use without abstinence on human immunodeficiency virus viral load
AU - Nance, Robin M.
AU - Trejo, Maria Esther Perez
AU - Whitney, Bridget M.
AU - Delaney, Joseph A.C.
AU - Altice, Fredrick L.
AU - Beckwith, Curt G.
AU - Chander, Geetanjali
AU - Chandler, Redonna
AU - Christopoulous, Katerina
AU - Cunningham, Chinazo
AU - Cunningham, William E.
AU - Rio, Carlos Del
AU - Donovan, Dennis
AU - Eron, Joseph J.
AU - Fredericksen, Rob J.
AU - Kahana, Shoshana
AU - Kitahata, Mari M.
AU - Kronmal, Richard
AU - Kuo, Irene
AU - Kurth, Ann
AU - Chris Mathews, W.
AU - Mayer, Kenneth H.
AU - Moore, Richard D.
AU - Mugavero, Michael J.
AU - Ouellet, Lawrence J.
AU - Quan, Vu M.
AU - Saag, Michael S.
AU - Simoni, Jane M.
AU - Springer, Sandra
AU - Strand, Lauren
AU - Taxman, Faye
AU - Young, Jeremy D.
AU - Crane, Heidi M.
N1 - Funding Information:
Financial support. Research presented in this article is the result of secondary data analysis and was supported by 5U01DA037702 from the National Institute on Drug Abuse (NIDA). In addition, this work was supported by the National Institutes of Alcohol Abuse and Alcoholism at the NIH (U24AA020801, U01AA020793, and U01AA020802). Additional support came from the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH (CNICS R24 AI067039, UW CFAR NIAID grant P30 AI027757; UNC CFAR grant P30 AI50410, JHU CFAR grant P30 AI094189, and UAB CFAR grant P30 AI027767). Additional support came from the NIDA (U01DA036935 and R01DA047045). Primary data collection for STTR studies was supported by grants R01DA030768, R01DA030747, R01DA030781, R01DA030771, R01MH094090, R01DA030778, R01DA030766, R01DA030770, R01DA030762, R01DA030776, R01DA030793, R01DA032059, R01DA032083, R01DA032106, R01DA032061, R01DA032110, R01DA032080, R01DA032082, R01DA032057, R01DA032098, R34DA035728, and R01DA032100.
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - Abstinence
KW - Drug use
KW - Heroin
KW - Substance use
KW - Viral suppression
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U2 - 10.1093/cid/ciz299
DO - 10.1093/cid/ciz299
M3 - Article
C2 - 30994900
AN - SCOPUS:85079353968
SN - 1058-4838
VL - 70
SP - 867
EP - 874
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -
