Alcohol and substance use diagnoses among HIV-positive patients receiving care in NYC clinic settings

Abstract

Background Substance use among HIV-positive persons exacerbates health problems. This study sought to estimate the prevalence of alcohol and drug-use diagnoses and examined hypothesized predictors associated with alcohol and drug-use diagnoses among HIV-positive patients in New York City (NYC). Methods This cohort study reviewed electronic medical records (EMRs) of 4,965 HIV-positive patients based on diagnostic codes. These patients attended a comprehensive care clinic in NYC in 2012. Multinomial logistic regression was used to predict the odds of classification into substance use diagnosis grouping. Results Of the full sample, only 12.7% of patients had an alcohol use diagnosis documented in their EMR compared with more than one-quarter (26.4%) of patients having a recorded drug use diagnosis (p < 0.001). Compared with the No Alcohol or Drugs group, the regression model showed that older age and having a recent inpatient hospital stay independently predicted being in the Alcohol Only group; years living with HIV, having an unsuppressed viral load, and having a recent inpatient hospital stay were associated with higher odds of being in the Drugs Only and Alcohol and Drugs groups; and being women and men who have sex with men (MSM) were associated with decreased odds of being in the Drugs Only and Alcohol and Drugs groups. Conclusions Substance use diagnosis was associated with viremia and low CD4 counts and hospital stays. This implies that providers should screen for substance use in HIV-positive patients with poor health. Further examination of the extent of such comorbidity is instrumental for intervention efforts.

Correlates of Validity of Self-Reported Methamphetamine Use among a Sample of Dependent Adults

“…Age, race, gender, income, education, polysubstance use, visit number, and visit type were assessed as potential correlates of validity based on prior literature showing associations between these characteristics and validity of self-reported substance use in different settings (Fendrich, Mackesy-Amiti, & Johnson, 2008; Langendam, van Haastrecht, & van Ameijden, 1999; Rendon et al, 2017; Schuler, Lechner, Carter, & Malcolm, 2009; White et al, 2014). Sexual orientation, HIV status, and depression were included as exploratory candidates based on elevated rates of substance use among sexual minorities (Medley et al, 2016), HIV-positive individuals (Gurung et al, 2017), and those suffering from depression (Swendsen & Merikangas, 2000), which make the validity of self-reported substance use among these groups of particular interest.…”

Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis

“…Both unemployment and educational level are linked to a higher socioeconomic status, which may indicate better access to health care and to nutritious food. Substance use (e.g., marijuana, alcohol, methamphetamine, cocaine, and others) among PLHIV also seems to be an important moderator of sarcopenia, perhaps directly or indirectly through suboptimal adherence to ARV [61,62] Furthermore, several bone-related abnormalities (i.e., low bone mineral density, osteoporosis, osteopenia, osteomalacia, and fractures) have been observed in PLHIV, likely influenced by both HIV, lifestyle factors, and ART [63].…”

Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research

“…54,55 The study of hazardous alcohol use is especially important because of the deleterious effects on immune functioning caused by alcohol use, 56 which could increase the risk for HIV-seroconversion with inadequate PrEP adherence. One study of GBM in Atlanta found that 75% endorsed beliefs that alcohol had interactive toxicity effects with anti-retroviral medications; however, the study did not investigate if GBM purposefully missed PrEP doses timed around binge drinking events.…”

“…Similar to club drugs, heavy alcohol use results in behavioral disinhibiting effects; 50 hazardous alcohol use has been associated with greater CAS among GBM 51 and lower HIV mediation adherence among samples of persons living with HIV including GBM, 52,53 particularly when used in combination with other drugs. 54,55 The study of hazardous alcohol use is especially important because of the deleterious effects on immune functioning caused by alcohol use, 56 which could increase the risk for HIV-seroconversion with inadequate PrEP adherence. One study of GBM in Atlanta found that 75% endorsed beliefs that alcohol had interactive toxicity effects with anti-retroviral medications; however, the study did not investigate if GBM purposefully missed PrEP doses timed around binge drinking events.…”