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

Robin M. Nance, Maria Esther Perez Trejo, Bridget M. Whitney, Joseph A.C. Delaney, Fredrick L. Altice, Curt G. Beckwith, Geetanjali Chander, Redonna Chandler, Katerina Christopoulous, Chinazo Cunningham, William E. Cunningham, Carlos Del Rio, Dennis Donovan, Joseph J. Eron, Rob J. Fredericksen, Shoshana Kahana, Mari M. Kitahata, Richard Kronmal, Irene Kuo, Ann KurthW. Chris Mathews, Kenneth H. Mayer, Richard D. Moore, Michael J. Mugavero, Lawrence J. Ouellet, Vu M. Quan, Michael S. Saag, Jane M. Simoni, Sandra Springer, Lauren Strand, Faye Taxman, Jeremy D. Young, Heidi M. Crane

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)867-874
Number of pages8
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume70
Issue number5
DOIs
StatePublished - Feb 14 2020

    Fingerprint

Keywords

  • abstinence
  • drug use
  • heroin
  • substance use
  • viral suppression

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Nance, R. M., Trejo, M. E. P., Whitney, B. M., Delaney, J. A. C., Altice, F. L., Beckwith, C. G., Chander, G., Chandler, R., Christopoulous, K., Cunningham, C., Cunningham, W. E., Del Rio, C., Donovan, D., Eron, J. J., Fredericksen, R. J., Kahana, S., Kitahata, M. M., Kronmal, R., Kuo, I., ... Crane, H. M. (2020). Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 70(5), 867-874. https://doi.org/10.1093/cid/ciz299