Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load

Abstract

Background Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. Methods This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. Results The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4–2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). Conclusions Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.

The Prevalence and Negative Impacts of Substance Use Disorders among People with HIV in the United States: A Real-Time Delphi Survey of Key Stakeholders

“…Moreover, this study advances knowledge regarding the individual-level and population-level negative impacts of five different SUDs on PWH within the U.S. In addition to further demonstrating the need for integrating SUD services within HIV settings [1,5,[54][55][56][57][58], our findings may help national-, state-, and county-level policymakers, HPCs, and ASOs refine how their finite funding is allocated for addressing the HIV-SUD syndemic within the U.S.…”

Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study

“…Data from the Alcohol Use Disorders Identification Test and the National Institute of Drug Abuse-modified Alcohol, Smoking, and Substance Involvement Test were utilized to examine the association of past or current substance abuse with CKD development. 40 , 41 , 42 , 43 Each substance (marijuana, methamphetamine, illicit opioid, intravenous drug use, cocaine/crack, and high risk alcohol use) was examined independently given the distinctly different mechanisms by which they may impact kidney function.…”

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

“…To increase diagnosis and treatment of SUDs, screening for and linkage to SUD treatment should be integrated into HIV prevention and treatment services (evidence rating: AIa) (eTable 4 in the Supplement). Reducing substance use (even if abstinence is not achieved) is associated with improved HIV outcomes . Therefore, offering addiction treatment, including pharmacotherapy and behavioral-based therapies, is recommended for all people with HIV with SUDs (evidence rating: AIa) …”