Association between substance use disorders and sustained viral suppression: a longitudinal analysis among people with HIV in South Carolina.

Objectives: Substance use disorders (SUDs) are a significant public health concern across the United States and may pose a risk to achieving sustained viral suppression (SVS) in people with HIV (PWH). This study aims to examine the association between SUDs and SVS among PWH.

Design: Using electronic health records from the South Carolina Department of Health, we conducted a retrospective study of adults diagnosed with HIV between January 2006 and December 2019.

Methods: The impact of SUDs on SVS was assessed using generalized linear mixed model. Potential confounders included age, sex, chronic diseases history, etc. Stepwise selection was performed to decide the confounders included in the final model, and the optimal correlation structure was determined by Akaike information criterion.

Results: Of the 9412 eligible participants, 7481 (79.48%) had reached SVS status during their follow-up periods. SUDs related to alcohol (adjusted odds ratio (AOR) = 1.70, 95% confidence interval (CI): 1.46-1.98), cannabis (AOR = 1.62, 95% CI: 1.35-1.95), cocaine (AOR = 1.95, 95% CI: 1.60-2.37), opioid (AOR = 1.91, 95% CI: 1.13-3.23), and tobacco (AOR = 1.80, 95% CI: 1.69-1.92) were negatively associated with SVS. Individuals with chronic conditions such as cardiovascular disease (AOR=0.31, 95% CI: 0.29-0.33), diabetes (AOR=0.49, 95% CI: 0.41-0.59), and cancer (AOR=0.47, 95% CI: 0.38-0.58) showed a higher likelihood of maintaining SVS.

Conclusion: This large cohort study of PWH with extended follow-up highlights the negative impact of SUDs on maintaining SVS. Long-term strategies for reducing substance use could support SVS in HIV patients.