Substance dependence criteria, not substance use, associated with HIV virologic control

Seonaid Nolan

S. Nolan1, A.Y. Walley2, T.C. Heeren2, G.J. Patts2, A.S. Ventura2, M. Sullivan2, J.H. Samet2, R. Saitz2. 1Department of Medicine, University of British Columbia, Canada; 2Boston University, United States

Background: This study aims to a) describe a cohort of HIV-infected people on antiretroviral therapy (ART) who use substances and b) explore which substance use-related factors are associated with lack of virologic control.

Methods: Participants were selected from the Boston ARCH cohort (i.e. HIV-infected adults with 12-month DSM-IV substance dependence or ever injection drug use) who were currently taking ART. Substance use predictors of interest included number of DSM-IV alcohol and drug dependence criteria and past 30 day substance specific use. Associations with HIV virologic control (HIV viral load [HVL] <200 vs >200 copies/mL) were tested using logistic regression models. Multivariable analyses were adjusted for age, gender, homelessness and anxiety or depression.

Results: Participants (n=200) were median age 50 years, 67% male, 51% African American, 76% self-reported >90% ART adherence, and 80% HVL <200 copies/mL. In the past 30 days, 52% reported the use of alcohol in heavy amounts, 77% cigarettes, 45% marijuana, 27% cocaine, 16% heroin, and 14% illicit prescription opioids. In unadjusted analyses, both number of DSM-IV alcohol dependence criteria (past 12 months)(odds ratio [OR]=1.18 for each additional criterion, 95% confidence interval [CI]: 1.03-1.34) and number of DSM-IV drug dependence criteria (OR=1.27, 95% CI: 1.09-1.48), but not alcohol, tobacco, marijuana, cocaine, heroin, or illicit opioid use, were associated with a detectable HVL. After adjusting for covariates, only number of drug dependence criteria remained significant (adjusted OR=1.21, 95% CI: 1.03-1.42).

Conclusion: More than 3/4 of an addiction HIV cohort had HIV virologic control and >90% ART adherence. Substance dependence criteria (drug dependence in particular), and not substance specific use, were associated with a lack of virologic control. This suggests that substance dependence criteria warrant particular clinical attention by HIV care providers.

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