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.