Alcohol, smoking, recreational drug use and association with virological outcomes among people living with HIV: cross‐sectional and longitudinal analyses

Abstract

Objectives: There is increasing evidence to suggest that people living with HIV (PLWH) have significant morbidity from alcohol, recreational drug use and cigarette smoking. Our aim was to report associations of these factors with antiretroviral therapy (ART) non-adherence, viral non-suppression and subsequent viral rebound in PLWH. Methods: The Antiretroviral Sexual Transmission Risk and Attitudes (ASTRA) study recruited PLWH attending eight outpatient clinics in England between February 2011 and December 2012. Data included self-reported excessive drinking (estimated consumption of > 20 units of alcohol/week), alcohol dependency (CAGE score ≥ 2 with current alcohol consumption), recreational drug use (including injection drug use in the past 3 months), and smoking status. Among participants established on ART, cross-sectional associations with ART non-adherence [missing ≥2 consecutive days of ART on ≥2 occasions in the past three months] and viral-non suppression [viral load (VL) > 50 copies/mL] were assessed using logistic regression. In participants from one centre, longitudinal associations with subsequent viral rebound (first VL > 200 copies/mL) in those on ART with VL ≤ 50 copies/mL at baseline were assessed using Cox regression during a 7-year follow-up.Results: Among 3258 PLWH, 2248 (69.0%) were men who have sex with men, 373 (11.4%) were heterosexual men, and 637 (19.6%) were women. A CAGE score ≥ 2 was found in 568 (17.6%) participants, 325 (10.1%) drank > 20 units/week, 1011 (31.5%) currently smoked, 1242 (38.1%) used recreational drugs and 74(2.3%) reported injection drug use. In each case, prevalence was much more common among men than among women. Among 2459 people on ART who started at least 6 months previously, a CAGE score ≥ 2, drinking > 20 units per week, current smoking, injection and non-injection drug use were all associated withThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Associations between HIV viremia during antiretroviral therapy and cardiovascular disease

“…Approximately 20% of Swedish PWH are smokers [27]. It is unlikely that smoking directly impacts HIV viremia [28]; nevertheless, smoking might be a marker of behavioral patterns (such as ART adherence) which could be linked to viral suppression [29,30]. Moreover, other factors, such as socio-economic conditions and psychiatric comorbidities have been associated with smoking [30], and could also influence viral response during ART [31,32].…”

Amphetamine‐related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020

“…However, the impact of recreational drug use on the management of HIV infection has been observed in the risk of transmission of infectious diseases, mainly sexually transmitted diseases [17,18] because of the higher prevalence of risk behaviours associated with drug use [19] and a negative impact on ART adherence [18,20,21], leading to a subsequent risk of therapy failure [21]. By contrast, other clinical complications of recreational drug use, such as drug intoxication and especially acute amphetamine intoxication, are a leading cause of mortality in people living with HIV [22][23][24][25][26][27].…”