Illicit drug use and HIV treatment outcomes in a US cohort.
OBJECTIVE
To determine the prevalence of illicit drug use and the impact on HIV treatment.


METHODS
Multivariable regression of cross-sectional data from 1163 HIV-infected and 294 controls from the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM).


METHODS
An analysis of (1) prevalence of specific illicit drug use (ever, current), (2) being on HAART among those with an indication and (3) current HIV RNA and CD4 cell count among HAART users.


RESULTS
Median age was 42 years, approximately 50% were non-Caucasian and 33% were women. Eighty-six percent of HIV-infected and 67% of controls reported ever using illicit drugs (P < 0.0001); 28% of HIV-infected and 16% of controls reported current use (P = 0.0001). In adjusted models, current cocaine use and past heroin use were associated with not currently being on HAART. Among HAART users, those reporting past heroin use were as likely to have an undetectable HIV viral load as those who had never used heroin. Current and past cocaine use and current heroin use was associated with lower odds of undetectable HIV RNA. Past amphetamine use was associated with having an undetectable HIV. Similar results were seen for CD4 lymphocyte counts.


CONCLUSIONS
Illicit drug use in the US is common, although far fewer report current use than past use. Among HIV-infected patients, understanding of the type of illicit drugs used and whether drug use was in the past or ongoing is important, because of their differential effects on HIV treatment outcomes.
Cofrancesco
Joseph
J
Johns Hopkins School of Medicine, Department of Medicine, Baltimore, Maryland, USA.
Scherzer
Rebecca
R
Tien
Phyllis C
PC
Gibert
Cynthia L
CL
Southwell
Heather
H
Sidney
Stephen
S
Dobs
Adrian
A
Grunfeld
Carl
C
D000328:Adult; D000662:Amphetamines; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006556:Heroin Dependence / Q000150:complications / Q000453:epidemiology; D006801:Humans; D013287:Illicit Drugs; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D000662:Amphetamines; D013287:Illicit Drugs