Active cocaine use is associated with lack of HIV-1 virologic suppression independent of nonadherence to antiretroviral therapy: use of a rapid screening tool during routine clinic visits.
Clarifying the relationship between illicit drug use and HIV-1 virologic suppression requires characterization of both illicit drug use activity and adherence to antiretroviral therapy (ART). We developed a rapid clinical questionnaire to assess prior 7-day illicit drug use and ART adherence in a cross-sectional study among 1777 HIV-infected persons in care. Of these, 76% were male, 35% were African-American, and 8% reported injection drug use as their probable route of HIV-1 infection. Questionnaire-reported frequencies of cocaine and marijuana use within the previous 7 days were 3.3% and 12.1%, respectively. Over three quarters (77.8%) of participants were on ART, of whom 69.7% had HIV-1 virologic suppression (HIV-1 RNA<48 copies/mL). Univariate analyses revealed that compared to no use, cocaine and marijuana use were both associated with missed ART doses (P<0.01). Multivariable logistic regression analysis adjusting for nonadherence demonstrated that cocaine use was independently associated with failing to achieve virologic suppression (adjusted odds ratio (aOR): 0.46; 95% confidence interval (95% CI): 0.22-0.98) but marijuana use was not (aOR: 1.08; 95% CI: 0.72-1.62). This result strengthens the evidence of a direct effect of cocaine on virologic control, independent of nonadherence to ART.
Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Daniel A
DA
Rasbach
Andrew J
AJ
Desruisseau
Aaron M
AM
Kipp
Samuel
S
Stinnette
Asghar
A
Kheshti
Bryan E
BE
Shepherd
Timothy R
TR
Sterling
Todd
T
Hulgan
Catherine C
CC
McGowan
Han-Zhu
HZ
Qian
D000328:Adult; D000553:Ambulatory Care; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood*; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents; D012367:RNA, Viral