Current drug use and lack of HIV virologic suppression: point-of-care urine drug screen versus self-report

Abstract

BackgroundThere have been inconsistent findings on the association between current drug use and HIV disease progression and virologic suppression. Drug use was often measured using self-report of historical use. Objective measurement of current drug use is preferred.MethodsIn this cross-sectional study, we assessed drug use through Computer-Assisted Self Interviews (CASI) and point-of-care urine drug screen (UDS) among 225 HIV-infected patients, and evaluated the association between current drug use and virologic suppression.ResultsAbout half (54%) of participants had a positive UDS, with a lower self-reported rate by CASI (42%) (Kappa score = 0.59). By UDS, 36.0% were positive for marijuana, 25.8% for cocaine, 7.6% for opiates, and 2.2% for methamphetamine or amphetamine. Factors associated with virologic suppression (plasma HIV RNA <50 copies/mL) were Caucasian race (P = 0.03), higher CD4 count (P < 0.01), current use of antiretroviral therapy (ART) (P < 0.01), and a negative UDS (P < 0.01). Among 178 current ART users, a positive UDS remained significantly associated with lower likelihood of virologic suppression (P = 0.04).ConclusionsUDS had good agreement with CASI in detecting frequently used drugs such as marijuana and cocaine. UDS at routine clinic visits may provide “real-time” prognostic information to optimize management.

Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders

“…In addition, individuals with mental illness are more likely to engage in risky behaviors (Clum, Chung, & Ellen, 2009) such as unprotected sexual activity and drug use (Meade & Sikkema, 2005). Engagement in these risky behaviors is associated with poor rates of viral suppression (Arnsten, et al, 2002; Mattson et al, 2014; Qian et al, 2014).…”

HIV-1 Tat and cocaine mediated synaptopathy in cortical and midbrain neurons is prevented by the isoflavone Equol

“…HIV-1+ individuals that use cocaine progress from HIV-1 infection to AIDS more quickly ( Baum et al, 2009 ), are more likely to develop neurocognitive disorders ( Levine et al, 2006 ; Nath, 2010 ), and display an accelerated progression of HIV-1 associated neurocognitive disorders (HAND; Nath, 2010 ). Neurocognitive dysfunction and drug abuse are two of the most common factors for medication non-compliance in treatment of HIV-1 ( Panos et al, 2014 ), and therefore HIV-1 positive drug abusers with neurocognitive disorders have a higher risk for disease progression, increased mortality rates, and a lower quality of life ( Wisniewski et al, 2005 ; Cook et al, 2007 ; Baum et al, 2009 ; Doshi et al, 2012 ; Qian et al, 2014 ).…”

Psychiatric Illness, Substance Use, and Viral Suppression Among HIV-Positive Men of Color Who Have Sex with Men in Los Angeles

“…Although there are definite limitations associated with the recent adherence measure, we used an unbiased and accurate objective measure to ascertain recent drug use (urine drug screens), as opposed to drug use over the past several months, and the most relevant biomarker of HIV disease status, RNA quantification using real-time PCR. Analogously, Qian et al [41] recently used urine drug screen information to demonstrate a significant association between a negative screen and viral suppression. In doing so, they advocated for the use of urine drug screens for rapid point-of-care screening at routine clinic visits to identify patients at risk for treatment failure and to drive patient management and referral to services such as directed adherence counseling and drug use treatment programs [41].…”

“…Analogously, Qian et al [41] recently used urine drug screen information to demonstrate a significant association between a negative screen and viral suppression. In doing so, they advocated for the use of urine drug screens for rapid point-of-care screening at routine clinic visits to identify patients at risk for treatment failure and to drive patient management and referral to services such as directed adherence counseling and drug use treatment programs [41]. Results presented here further support the consideration of real-time drug screen results to optimize HIV disease management.…”