Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load.
abstinence
drug use
heroin
substance use
viral suppression
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
14 02 2020
14 02 2020
Historique:
received:
22
10
2018
accepted:
11
04
2019
pubmed:
18
4
2019
medline:
7
1
2021
entrez:
18
4
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 30994900
pii: 5474820
doi: 10.1093/cid/ciz299
pmc: PMC7319266
doi:
Substances chimiques
Illicit Drugs
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
867-874Subventions
Organisme : NIDA NIH HHS
ID : R01 DA030776
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030771
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032061
Pays : United States
Organisme : NIDA NIH HHS
ID : R34 DA035728
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030762
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032082
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032098
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030778
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA020802
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032059
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030793
Pays : United States
Organisme : NIDA NIH HHS
ID : U01 DA037702
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030766
Pays : United States
Organisme : NIDA NIH HHS
ID : U01 DA036935
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027767
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032100
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH094090
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032083
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032057
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032106
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030781
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032110
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030770
Pays : United States
Organisme : NIAAA NIH HHS
ID : U24 AA020801
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL126538
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030768
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA047045
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA020793
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI094189
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032080
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030747
Pays : United States
Organisme : NIAID NIH HHS
ID : R24 AI067039
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050410
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
AIDS Behav. 2013 Oct;17 Suppl 2:S118-27
pubmed: 23673792
Am J Public Health. 2015 Dec;105(12):2416-22
pubmed: 26469642
AIDS Behav. 2017 Jul;21(7):1914-1925
pubmed: 28285434
Prev Sci. 2007 Mar;8(1):35-49
pubmed: 17096196
Harm Reduct J. 2014 Feb 21;11:7
pubmed: 24559062
Subst Use Misuse. 2018 Jul 29;53(9):1519-1528
pubmed: 29333954
J AIDS HIV Res. 2012 Feb;4(2):47-55
pubmed: 26561537
Psychosom Med. 2007 Nov;69(8):785-92
pubmed: 17942835
J Acquir Immune Defic Syndr. 2018 May 1;78(1):43-53
pubmed: 29373393
Arch Intern Med. 2003 Apr 14;163(7):821-9
pubmed: 12695273
Addiction. 2002 Sep;97(9):1183-94
pubmed: 12199834
Stat Med. 2015 Jun 30;34(14):2181-95
pubmed: 24634327
Int J Drug Policy. 2014 Sep;25(5):897-904
pubmed: 24857185
PLoS One. 2017 Jan 12;12(1):e0169078
pubmed: 28081178
JAMA. 2001 Nov 28;286(20):2568-77
pubmed: 11722271
Drug Alcohol Rev. 2005 May;24(3):217-26
pubmed: 16096125
AIDS Behav. 2017 Apr;21(4):1138-1148
pubmed: 27738780
J Acquir Immune Defic Syndr. 2003 Apr 15;32(5):522-6
pubmed: 12679704
J Gen Intern Med. 2001 Sep;16(9):625-33
pubmed: 11556944
Clin Infect Dis. 2014 Jul 1;59(1):123-6
pubmed: 24723283
Cochrane Database Syst Rev. 2003;(3):CD002208
pubmed: 12917925
J Acquir Immune Defic Syndr. 2018 Nov 1;79(3):283-287
pubmed: 30036277
BMC Infect Dis. 2016 Aug 27;16(1):455
pubmed: 27568002
J Stud Alcohol. 2002 Mar;63(2):179-86
pubmed: 12033694
Alcohol Clin Exp Res. 1998 Nov;22(8):1842-9
pubmed: 9835306
Curr HIV Res. 2007 Jan;5(1):109-18
pubmed: 17266562
BMC Infect Dis. 2016 Oct 21;16(1):590
pubmed: 27769246
Am J Public Health. 2013 Aug;103(8):1457-67
pubmed: 23763417
AIDS Res Hum Retroviruses. 2017 Feb 16;33(6):534-545
pubmed: 28092168
AIDS Behav. 2017 Jul;21(7):1791-1811
pubmed: 28365913
Drugs. 2006;66(6):769-89
pubmed: 16706551
Biom J. 2011 Sep;53(5):750-63
pubmed: 21834127
Subst Abuse Treat Prev Policy. 2017 May 16;12(1):24
pubmed: 28511680
J Infect Dis. 2003 Dec 1;188(11):1659-65
pubmed: 14639536
AIDS. 2008 Aug;22 Suppl 2:S81-92
pubmed: 18641473
Arch Gen Psychiatry. 2001 Aug;58(8):721-8
pubmed: 11483137
AIDS Patient Care STDS. 2010 Nov;24(11):705-12
pubmed: 20969465
Clin Infect Dis. 2016 Oct 15;63(8):1094-1104
pubmed: 27343545
Int J Epidemiol. 2008 Oct;37(5):948-55
pubmed: 18263650