Joint effects of substance use disorders and recent substance use on HIV viral non-suppression among people engaged in HIV care in an urban clinic, 2014–2019

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2023-07-25 DOI:10.1111/add.16301

Catherine R. Lesko, Oluwaseun O. Falade-Nwulia, Jarratt D. Pytell, Heidi E. Hutton, Anthony T. Fojo, Jeanne C. Keruly, Richard D. Moore, Geetanjali Chander

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引用次数: 1

Abstract

Aims

To estimate the joint effects of substance use disorder (SUD) and recent substance use on human immunodeficiency virus (HIV) non-suppression.

Design

Retrospective clinical cohort study with repeated observations within individuals.

Setting

Baltimore, Maryland, United States.

Participants

1881 patients contributed 10 794 observations.

Measurements

The primary independent variable was the combination of history of SUD and recent substance use. History of SUD was defined as any prior International Classification of Diseases 9/10 code for cocaine or opioid disorder. Recent substance use was defined as the self-report of cocaine or non-prescribed opioid use on the National Institute of Drug Abuse-modified Alcohol, Smoking and Substance Involvement Screening Test or clinician-documented cocaine or opioid use abstracted from the medical record. The outcome was viral non-suppression, defined as HIV RNA >200 copies/mL on the first viral load measurement within 1 year subsequent to each observation of substance use. We adjusted for birth sex, Black race, age, HIV acquisition risk factors, years in care and CD4 cell count. In secondary analyses, we also adjusted for depressive, anxiety and panic symptoms, cannabis use and cannabis use disorder.

Findings

On their first observation, 31% of patients had a history of an SUD and 18% had recent substance use. Relative to no history of SUD and no recent substance use, the 1-year fully adjusted risk difference (RD) for viral non-suppression associated with cocaine and opioid use disorder and recent substance use was 7.7% (95% CI = 5.3%–10.0%), the RD was 5.5% (95% CI = 1.2%–9.7%) for history of cocaine use disorder without recent substance use, and the RD was 4.6% (95% CI = 2.7%–6.5%) for recent substance use without a SUD.

Conclusions

Substance use and substance use disorders appear to be highly prevalent among, and independently associated with, viral non-suppression among people with HIV.

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2014-2019年，在一家城市诊所从事HIV护理的人群中，药物使用障碍和最近药物使用对HIV病毒不抑制的联合影响

目的评估药物使用障碍（SUD）和近期药物使用对人类免疫缺陷病毒（HIV）非抑制的联合影响。设计在个体内重复观察的回顾性临床队列研究。背景美国马里兰州巴尔的摩。参与者1881名患者贡献了10 794次观察。测量主要自变量是SUD病史和近期药物使用的组合。SUD病史被定义为可卡因或阿片类药物障碍的任何先前的国际疾病分类9/10代码。最近的药物使用被定义为在国家药物滥用研究所修改的酒精、吸烟和药物参与筛查测试中自我报告可卡因或非处方阿片类药物的使用，或从医疗记录中提取临床医生记录的可卡因或阿片类药的使用。结果是病毒非抑制，定义为HIV RNA>；200 每次观察物质使用后1年内首次病毒载量测量的拷贝数/mL。我们对出生性别、黑人种族、年龄、HIV感染风险因素、护理年限和CD4细胞计数进行了调整。在二次分析中，我们还调整了抑郁、焦虑和恐慌症状、大麻使用和大麻使用障碍。结果在他们的第一次观察中，31%的患者有SUD病史，18%的患者最近使用过药物。相对于无SUD史和近期无药物使用史，与可卡因和阿片类药物使用障碍相关的病毒未抑制和近期药物使用的1年完全调整风险差（RD）为7.7%（95%CI=5.3%-10.0%），可卡因使用障碍史和近期未使用药物的RD为5.5%（95%CI=1.2%-9.7%），最近未使用SUD的药物的RD为4.6%（95%CI=2.7%-6.5%）。结论药物使用和药物使用障碍在HIV感染者中高度流行，并与病毒不抑制独立相关。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.