Stimulant Use and Progression to AIDS or Mortality After the Initiation of Highly Active Antiretroviral Therapy

Abstract

Background HIV-positive persons who use stimulants (e.g., methamphetamine) experience profound health disparities, but it remains unclear if these persist after highly active anti-retroviral therapy (HAART) initiation. Conducted within the Multicenter AIDS Cohort Study, this investigation examined if stimulant use is associated with progression to AIDS or all-cause mortality after the initiation of HAART. Methods Using marginal structural modeling, the cumulative proportion of visits where any stimulant use was reported (i.e., 0%, 1 – 49%, 50 – 99%, and 100%) was examined as a time-varying predictor of: 1) all-cause mortality; and 2) AIDS or all-cause mortality. Results Among the 1,313 men who have sex with men (MSM) who initiated HAART, findings showed no significant association of any level of stimulant use with all-cause mortality. A competing risks analysis indicated that no level of stimulant use was associated with increased AIDS-related or non-AIDS mortality separately. Among the 648 participants without AIDS at HAART initiation, a secondary analysis indicated that stimulant use at 50% or more of study visits was associated with a 1.5-fold increase in the odds of progression to AIDS or all-cause mortality (Adjusted OR = 1.54; 95% CI = 1.02 – 2.33, p < .05). Conclusions HIV-positive, stimulant-using MSM receiving HAART appear to face no greater overall risks for all-cause, AIDS-related, or non-AIDS mortality compared to non-users. However, men without AIDS at HAART initiation who more frequently reported stimulant use demonstrated modestly increased odds of progression to AIDS or all-cause mortality. Comprehensive approaches are needed to optimize the effectiveness of HAART with stimulant-using MSM.

Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study

“…As such, our one-item question may have underestimated the true relationship between social support, viral suppression, syndemic, and effect modification of the syndemic-viral load association. Third, although we controlled for adherence in our models using an established adherence measure (Carrico et al, 2014; Shoptaw et al, 2012), self-reported adherence is subject to recall and response biases, which may explain why we found a relationship between social support and viral load but no relationship between social support and adherence (Lu et al, 2008). Fourth, our measure of syndemic indicators (a count of concomitant depression symptoms, polysubstance use, and condomless anal sex with casual male partners) treats each component with equal weighting, hence ignoring effect size differences within these variables in relation to viral load (Ronald Stall, Coulter, Friedman, & Plankey, 2015; Tsai & Burns, 2015).…”

“…Participants responded to a single-item question (“On average, how often did you take your medication as prescribed?”) assessing frequency of all ART medication use as prescribed since last visit. Response options included 100% of the time; 95 – 99% of the time; 75 – 94% of the time; and <75% of the time (Carrico et al, 2014; Shoptaw et al, 2012). …”

Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men

“…10-12 Studies conducted with HIV-positive persons also highlight that unhealthy drinking and stimulant use are associated with elevated HIV viral load, 13-15 greater risk of onward HIV transmission, 16-18 and potentially faster HIV disease progression. 19-21 The relevance of alcohol and other substance use for HIV/AIDS prevention underscores the need for comprehensive, bio-behavioral interventions targeting substance-using MSM (SUMSM).…”

Preintervention Profiles of Information, Motivational, and Behavioral Self-Efficacy for Methamphetamine Use and HIV Medication Adherence Among Gay and Bisexual Men

“…6 Methamphetamine users are also less likely to receive HIV care after being diagnosed with HIV. 13 These factors contribute to worse HIV disease outcomes 16 such as more rapid HIV progression, [16][17][18] increased viral loads, 1 and increased resistance to highly active antiretroviral therapy (HAART). 19,20 In addition to HIV-related health consequences, the use of crystal methamphetamine has been associated with negative mental health consequences, particularly among HIVpositive GBM.…”