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. 2020 Feb 14;70(5):867-874.
doi: 10.1093/cid/ciz299.

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

Robin M Nance  1 , Maria Esther Perez Trejo  1 , Bridget M Whitney  1 , Joseph A C Delaney  1 , Fredrick L Altice  2 , Curt G Beckwith  3 , Geetanjali Chander  4 , Redonna Chandler  5 , Katerina Christopoulous  6 , Chinazo Cunningham  7 , William E Cunningham  8 , Carlos Del Rio  9 , Dennis Donovan  10 , Joseph J Eron  11 , Rob J Fredericksen  12 , Shoshana Kahana  5 , Mari M Kitahata  12 , Richard Kronmal  1 , Irene Kuo  13 , Ann Kurth  14 , W Chris Mathews  15 , Kenneth H Mayer  16 , Richard D Moore  17 , Michael J Mugavero  18 , Lawrence J Ouellet  19 , Vu M Quan  20 , Michael S Saag  18 , Jane M Simoni  21 , Sandra Springer  2 , Lauren Strand  1 , Faye Taxman  22 , Jeremy D Young  19 , Heidi M Crane  12
Affiliations

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

Robin M Nance et al. Clin Infect Dis. .

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.

Keywords: abstinence; drug use; heroin; substance use; viral suppression.

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Figures

Figure 1.
Figure 1.
Frequency of drug use at baseline among people living with human immunodeficiency virus who are current users of each drug.
Figure 2.
Figure 2.
Observed changes in frequency among people living with human immunodeficiency virus who are current users of each drug at baseline.
Figure 3.
Figure 3.
The association of decreasing or abstinence of 4 classes of drug use with undetectable viral load. Abbreviation: CI, confidence interval.
Figure 4.
Figure 4.
The associations of decreasing or abstinence of 4 classes of drug use with relative viral load using fixed-effects meta-analysis to pool drug-specific estimates across studies. Abbreviation: CI, confidence interval.
See this image and copyright information in PMC

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