title: Patterns of drug use and abuse among aging adults with and without HIV: a latent class analysis of a US Veteran cohort.
abstract: This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and socio-demographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22-86), primarily male (95%) and African-American (64%). Five distinct patterns emerged: non-users, past primarily marijuana users, past multidrug users, current high consequence multidrug users, and current low consequence primarily marijuana users. HIV status strongly influenced class membership. Non-users were most prevalent among HIV uninfected (36.4%) and current high consequence multidrug users (25.5%) were most prevalent among HIV-infected. While problems of obesity marked those not currently using drugs, current users experienced higher prevalences of medical or mental health disorders. Multimorbidity was highest among past and current multidrug users. HIV-infected participants were more likely than HIV-uninfected participants to be current low consequence primarily marijuana users. In this sample, active drug use and abuse were common. HIV-infected and uninfected Veterans differed on extent and patterns of drug use and on important characteristics within identified classes. Findings have the potential to inform screening and intervention efforts in aging drug users with and without HIV.
authors.affiliation: Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States. traci.c.green@brown.edu
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.forename: Trace
authors.initials: T
authors.lastname: Kershaw
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kraemer
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.forename: Steve A
authors.initials: SA
authors.lastname: Maisto
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Day
authors.forename: Kendall
authors.initials: K
authors.lastname: Bryant
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D003198:Computer Simulation; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology; D008875:Middle Aged; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology*; D014728:Veterans; D055815:Young Adult
references.citation: Arch Intern Med. 2007 Jan 22;167(2):166-73
references.pmid: 17242318
references.citation: MMWR Morb Mortal Wkly Rep. 2009 Apr 10;58(13):329-32
references.pmid: 19357632
references.citation: AIDS Patient Care STDS. 2005 Jul;19(7):460-5
references.pmid: 16053403
references.citation: Top HIV Med. 2006 Dec-2007 Jan;14(5):159-63
references.pmid: 17237557
references.citation: Med Clin North Am. 1997 Jul;81(4):831-43
references.pmid: 9222256
references.citation: Int J Addict. 1995 Nov-Dec;30(13-14):1925-51
references.pmid: 8751324
references.citation: J Clin Epidemiol. 2001 Dec;54 Suppl 1:S3-8
references.pmid: 11750202
references.citation: BMC Health Serv Res. 2006 Feb 27;6:19
references.pmid: 16504167
references.citation: Arch Gen Psychiatry. 2001 May;58(5):503-8
references.pmid: 11343531
references.citation: N Engl J Med. 2009 Apr 30;360(18):1815-26
references.pmid: 19339714
references.citation: Med Care. 1996 Mar;34(3):220-33
references.pmid: 8628042
references.citation: J Consult Clin Psychol. 2004 Jun;72(3):400-10
references.pmid: 15279524
references.citation: J Acquir Immune Defic Syndr. 2005 Jan 1;38(1):43-6
references.pmid: 15608523
references.citation: Arch Intern Med. 1998 Sep 14;158(16):1789-95
references.pmid: 9738608
references.citation: AIDS Patient Care STDS. 2007 May;21(5):347-55
references.pmid: 17518527
references.citation: JAMA. 1999 Jun 23-30;281(24):2305-15
references.pmid: 10386555
references.citation: J Urban Health. 2000 Dec;77(4):678-87
references.pmid: 11194310
references.citation: Subst Use Misuse. 2005;40(8):1051-69
references.pmid: 16040368
references.citation: Clin Infect Dis. 2008 Aug 15;47(4):542-53
references.pmid: 18627268
references.citation: Expert Rev Clin Pharmacol. 2008 Jan;1(1):115-27
references.pmid: 24410515
references.citation: Drug Alcohol Depend. 2007 Apr 17;88(1):1-8
references.pmid: 17049753
references.citation: AIDS. 2005 Oct;19 Suppl 3:S99-105
references.pmid: 16251836
references.citation: J Addict Dis. 2004;23(2):95-107
references.pmid: 15132345
references.citation: Health Serv Res. 2000 Feb;34(6):1273-302
references.pmid: 10654830
references.citation: Am J Geriatr Psychiatry. 2009 Apr;17(4):281-90
references.pmid: 19307857
references.citation: J Midwifery Womens Health. 2000 Mar-Apr;45(2):176-82
references.pmid: 10812863
references.citation: J Acquir Immune Defic Syndr. 2007 Aug 15;45(5):545-54
references.pmid: 17589370
references.citation: Med Clin North Am. 1997 Jul;81(4):999-1016
references.pmid: 9222265
references.citation: Psychiatr Serv. 2000 Jul;51(7):890-2
references.pmid: 10875953
references.citation: Alcohol Clin Exp Res. 2004 Feb;28(2):313-21
references.pmid: 15112939
references.citation: Clin Infect Dis. 2007 Sep 15;45(6):770-8
references.pmid: 17712763
references.citation: Health Psychol. 2009 Jan;28(1):1-10
references.pmid: 19210012
references.citation: Med Care. 2006 Aug;44(8 Suppl 2):S13-24
references.pmid: 16849964
references.citation: MMWR Morb Mortal Wkly Rep. 2008 Sep 12;57(36):985-9
references.pmid: 18784639
references.citation: Subst Use Misuse. 2008;43(3-4):539-72; discussion 573-9, 585-7
references.pmid: 18365950
references.citation: Arch Intern Med. 2001 Jan 22;161(2):248-51
references.pmid: 11176739
references.citation: Int J Methods Psychiatr Res. 2004;13(2):93-121
references.pmid: 15297906
references.citation: Med Care. 2006 Aug;44(8 Suppl 2):S1-6
references.pmid: 16849963
references.citation: AIDS. 2005 Jun 10;19(9):935-42
references.pmid: 15905674
references.citation: Am J Geriatr Pharmacother. 2006 Dec;4(4):380-94
references.pmid: 17296542
references.citation: Drug Alcohol Depend. 2003 Mar 1;69(2):127-35
references.pmid: 12609694
references.citation: AIDS. 2004 Jan 1;18 Suppl 1:S43-8
references.pmid: 15075497
references.citation: Clin Infect Dis. 2004 Jun 1;38 Suppl 5:S376-87
references.pmid: 15156426
references.citation: CMAJ. 2005 Jul 5;173(1):16; author reply 17
references.pmid: 15997028
references.citation: AIDS Care. 2007 Feb;19(2):295-301
references.pmid: 17364413
references.citation: Womens Health Issues. 2006 Jan-Feb;16(1):30-7
references.pmid: 16487922
references.citation: Clin Infect Dis. 2005 Oct 1;41(7):1027-34
references.pmid: 16142670
references.citation: Clin Infect Dis. 2006 Aug 15;43(4):525-31
references.pmid: 16838244
references.citation: Med Care. 2006 Aug;44(8 Suppl 2):S37-43
references.pmid: 16849967
references.citation: Addiction. 1996 Dec;91(12):1765-72
references.pmid: 8997759
references.citation: Eval Rev. 2007 Dec;31(6):515-47
references.pmid: 17986706
references.citation: Phys Ther. 2005 Mar;85(3):257-68
references.pmid: 15733050
references.citation: Med Care. 2006 Aug;44(8 Suppl 2):S52-60
references.pmid: 16849969
references.citation: AIDS Patient Care STDS. 2004 Dec;18(12):702-13
references.pmid: 15659881
references.citation: Curr HIV/AIDS Rep. 2008 Aug;5(3):150-8
references.pmid: 18627664
references.citation: Lancet. 2001 May 5;357(9266):1397-401
references.pmid: 11356437
references.citation: Addiction. 1997 Aug;92(8):1017-22
references.pmid: 9376771
references.citation: J Acquir Immune Defic Syndr. 2003 May 1;33(1):96-103
references.pmid: 12792361
references.citation: Ann Intern Med. 2007 Jan 16;146(2):87-95
references.pmid: 17227932
references.citation: Subst Abus. 2002 Sep;23(3):149-64
references.pmid: 12444348
references.citation: Am J Public Health. 2000 Mar;90(3):352-9
references.pmid: 10705851
references.citation: Health Serv Res. 2007 Apr;42(2):755-72
references.pmid: 17362216
references.citation: Arch Gen Psychiatry. 1988 Dec;45(12):1069-77
references.pmid: 2848472
references.citation: Clin Infect Dis. 2005 Sep 15;41(6):864-72
references.pmid: 16107987
references.citation: Lancet. 2009 Apr 18;373(9672):1352-63
references.pmid: 19361855
references.citation: Int J Methods Psychiatr Res. 2008;17(2):89-103
references.pmid: 18393262
references.citation: Drug Alcohol Depend. 2004 Jun 11;74(3):235-44
references.pmid: 15194201
references.citation: Psychol Methods. 2005 Mar;10(1):21-39
references.pmid: 15810867
references.citation: Ann Epidemiol. 2006 Apr;16(4):257-65
references.pmid: 16275134
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571
references.citation: Clin Infect Dis. 2007 Dec 15;45(12):1593-601
references.pmid: 18190322
references.citation: J Clin Epidemiol. 2001 Dec;54 Suppl 1:S22-8
references.pmid: 11750206
references.citation: J Acquir Immune Defic Syndr. 2006 Sep;43(1):27-34
references.pmid: 16878047
references.citation: Addiction. 2009 Jan;104(1):88-96
references.pmid: 19133892
references.citation: Addiction. 2006 Sep;101 Suppl 1:6-16
references.pmid: 16930156
references.citation: Addiction. 2007 Jan;102(1):94-104
references.pmid: 17207127
references.citation: JAMA. 1993 Feb 10;269(6):729-30
references.pmid: 8093740
references.citation: Addiction. 2006 Aug;101(8):1133-42
references.pmid: 16869843
references.citation: Arch Intern Med. 2001 May 28;161(10):1281-8
references.pmid: 11371255