title: Stimulant use and progression to AIDS or mortality after the initiation of highly active antiretroviral therapy.
abstract: BACKGROUND
  HIV-positive persons who use stimulants (eg, methamphetamine) experience profound health disparities, but it remains unclear whether these persist after highly active antiretroviral therapy (HAART) initiation. Conducted within the Multicenter AIDS Cohort Study, this investigation examined whether stimulant use is associated with progression to AIDS or all-cause mortality after the initiation of HAART.
  
  
  METHODS
  Using marginal structural modeling, the cumulative proportion of visits where any stimulant use was reported (ie, 0%, 1%-49%, 50%-99%, and 100%) was examined as a time-varying predictor of (1) all-cause mortality and (2) AIDS or all-cause mortality.
  
  
  RESULTS
  Among the 1313 men who have sex with men (MSM) who initiated HAART, findings showed no significant association of any level of stimulant use with all-cause mortality. A competing risk analysis indicated that no level of stimulant use was associated with increased AIDS-related or non-AIDS mortality separately. Among the 648 participants without AIDS at HAART initiation, a secondary analysis indicated that stimulant use at 50% or more of study visits was associated with a 1.5-fold increase in the odds of progression to AIDS or all-cause mortality (adjusted odds ratio = 1.54; 95% confidence interval: 1.02 to 2.33; P < 0.05).
  
  
  CONCLUSIONS
  HIV-positive stimulant-using MSM receiving HAART seem to face no greater overall risks for all-cause, AIDS-related, or non-AIDS mortality compared with nonusers. However, men without AIDS at HAART initiation who more frequently reported stimulant use demonstrated modestly increased odds of progression to AIDS or all-cause mortality. Comprehensive approaches are needed to optimize the effectiveness of HAART with stimulant-using MSM.
authors.affiliation: *Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA; †Departments of Family Medicine and Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, CA; ‡Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; §Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; ‖The Chicago MACS and Ostrow & Associates, LLC, Chicago, IL; and ¶Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.forename: Steven
authors.initials: S
authors.lastname: Shoptaw
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Ronald
authors.initials: R
authors.lastname: Stall
authors.forename: Xiuhong
authors.initials: X
authors.lastname: Li
authors.forename: David G
authors.initials: DG
authors.lastname: Ostrow
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
authors.forename: Michael W
authors.initials: MW
authors.lastname: Plankey
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D016019:Survival Analysis