Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load
| Autor: | Chinazo O. Cunningham, Michael J. Mugavero, Carlos del Rio, Lawrence J. Ouellet, Jane M. Simoni, Maria Esther Perez Trejo, Richard A. Kronmal, Richard D. Moore, Lauren N. Strand, Michael S. Saag, Kenneth H. Mayer, Robin M. Nance, Irene Kuo, Shoshana Y. Kahana, W. Chris Mathews, Joseph A.C. Delaney, Katerina Christopoulous, Heidi M. Crane, Geetanjali Chander, Rob J. Fredericksen, Vu Minh Quan, Curt G. Beckwith, Redonna K. Chandler, William E. Cunningham, Bridget M. Whitney, Jeremy D. Young, Ann E. Kurth, Faye S. Taxman, Mari M. Kitahata, Dennis M. Donovan, Sandra A. Springer, Fredrick L Altice, Joseph J. Eron |
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| Rok vydání: | 2019 |
| Předmět: |
Microbiology (medical)
Drug viral suppression medicine.medical_specialty Substance-Related Disorders media_common.quotation_subject substance use HIV Infections Medical and Health Sciences Microbiology Methamphetamine Heroin Substance Misuse 03 medical and health sciences 0302 clinical medicine Clinical Research Internal medicine Behavioral and Social Science medicine Humans Longitudinal Studies 030212 general & internal medicine abstinence Articles and Commentaries drug use media_common Harm reduction 030505 public health Illicit Drugs business.industry Prevention HIV Odds ratio Biological Sciences Viral Load Abstinence medicine.disease Substance abuse Good Health and Well Being Infectious Diseases HIV/AIDS heroin Drug Abuse (NIDA only) Infection 0305 other medical science business Viral load medicine.drug |
| Zdroj: | Clin Infect Dis Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 70, iss 5 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciz299 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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