Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load.
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Nance Robin M, Trejo Maria Esther Perez, Whitney Bridget M, Delaney Joseph A C, Altice Fredrick L, Beckwith Curt G, Chander Geetanjali, Chandler Redonna, Christopoulous Katerina, Cunningham Chinazo, Cunningham William E, Del Rio Carlos, Donovan Dennis, Eron Joseph J, Fredericksen Rob J, Kahana Shoshana, Kitahata Mari M, Kronmal Richard, Kuo Irene, Kurth Ann, Mathews W Chris, Mayer Kenneth H, Moore Richard D, Mugavero Michael J, Ouellet Lawrence J, Quan Vu M, Saag Michael S, Simoni Jane M, Springer Sandra, Strand Lauren, Taxman Faye, Young Jeremy D, Crane Heidi M
Аннотация
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.