title: Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems cohort.
abstract: OBJECTIVE
  The purpose of this study was to better understand substance use behaviors and deleterious health consequences among individuals with HIV.
  
  
  METHODS
  We examined a multicenter cohort of HIV-infected patients (n = 3,413) receiving care in 4 US cities (Seattle, Birmingham, San Diego, Boston) between December 2005 and April 2010 in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We used generalized estimating equations to model specific substance use outcomes.
  
  
  RESULTS
  Overall, 24% of patients reported recent use of marijuana; 9% reported amphetamine use, 9% reported crack-cocaine use, 2% reported opiate use, 3.8% reported injection drug use, and 10.3% reported polydrug use. In adjusted multivariable models, those who reported unprotected anal sex had higher odds of marijuana, amphetamine, injection drug, and polydrug use. An increased number of distinct vaginal sexual partners was associated with polydrug and crack-cocaine use. Nonadherence to antiretroviral therapy was associated with the use of all substances other than marijuana.
  
  
  CONCLUSIONS
  The co-occurrence of substance use, unprotected intercourse, and medication nonadherence could attenuate the public health benefits of test, treat, and link to care strategies. Prevention programs are needed that address these coprevalent conditions.
authors.affiliation: Harvard Medical School/Massachusetts General Hospital, 1 Bowdoin Square, 7th floor, Boston, MA 02114, USA. mmimiaga@partners.org
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.forename: Chris
authors.initials: C
authors.lastname: Grasso
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schumacher
authors.forename: W Christopher
authors.initials: WC
authors.lastname: Mathews
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data; D011320:Primary Health Care; D012725:Sexual Behavior; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology