title: Current drug use and lack of HIV virologic suppression: point-of-care urine drug screen versus self-report.
abstract: BACKGROUND
  There have been inconsistent findings on the association between current drug use and HIV disease progression and virologic suppression. Drug use was often measured using self-report of historical use. Objective measurement of current drug use is preferred.
  
  
  METHODS
  In this cross-sectional study, we assessed drug use through Computer-Assisted Self Interviews (CASI) and point-of-care urine drug screen (UDS) among 225 HIV-infected patients, and evaluated the association between current drug use and virologic suppression.
  
  
  RESULTS
  About half (54%) of participants had a positive UDS, with a lower self-reported rate by CASI (42%) (Kappa score = 0.59). By UDS, 36.0% were positive for marijuana, 25.8% for cocaine, 7.6% for opiates, and 2.2% for methamphetamine or amphetamine. Factors associated with virologic suppression (plasma HIV RNA <50 copies/mL) were Caucasian race (P = 0.03), higher CD4 count (P < 0.01), current use of antiretroviral therapy (ART) (P < 0.01), and a negative UDS (P < 0.01). Among 178 current ART users, a positive UDS remained significantly associated with lower likelihood of virologic suppression (P = 0.04).
  
  
  CONCLUSIONS
  UDS had good agreement with CASI in detecting frequently used drugs such as marijuana and cocaine. UDS at routine clinic visits may provide "real-time" prognostic information to optimize management.
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA. han-zhu.qian@vanderbilt.edu.
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Mitchell
authors.forename: Sally
authors.initials: S
authors.lastname: Bebawy
authors.forename: Holly
authors.initials: H
authors.lastname: Cassell
authors.forename: Gina
authors.initials: G
authors.lastname: Perez
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Richard
authors.initials: R
authors.lastname: D'Aquila
authors.forename: Todd
authors.initials: T
authors.lastname: Hulgan
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D018450:Disease Progression; D055030:Drug Users / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000652:urine / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D013287:Illicit Drugs / Q000652:urine*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D057566:Self Report; D019966:Substance-Related Disorders / Q000150:complications / Q000276:immunology / Q000652:urine* / Q000821:virology; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D013287:Illicit Drugs