Substance Use Does Not Preclude HIV Control, Though Symptoms Do.
About one-third of the more than 1.2 million people living with HIV in the US drink alcohol in unhealthy amounts or use illicit drugs. But the vast majority of those who use substances and receive antiretroviral therapy (ART) still adhere to treatment and achieve viral control, according to a new study co-authored by School of Public Health researchers.
The study, in the journal AIDS Care, looked at adults with HIV who were receiving ART and their rates of adherence to treatment and virologic control. It found that HIV viral suppression was achieved in 78 percent of participants, even though past-30-day substance use was common among the group.
“Optimal HIV outcomes can be achieved by individuals who use alcohol or drugs, and addressing symptoms of substance dependence may improve HIV-related outcomes,” the study says.
In the study, 86 percent of participants had past 12-month substance dependence, and non-adherence to ART was “strongly associated” with a detectable viral load. But criteria for drug dependence, rather than specific substance use, were associated with a detectable viral load, after accounting for ART adherence—suggesting that poor viral control “is driven by the effect of substance use on one’s life, rather than use itself,” the authors said.
“Optimal HIV outcomes, including a reduction in the risk for HIV transmission, can be achieved by this population,” said co-author Richard Saitz, chair and professor of community health sciences. “People who use drugs can have their HIV disease well controlled. Drug use doesn’t seem to interfere much, unless it is accompanied by symptoms of a drug use disorder.”
Saitz and co-authors recommend that monitoring substance use and assessing and addressing symptoms should be a regular part of HIV care.
The study was led by Seonaid Nolan of the University of British Columbia, with SPH co-authors including Timothy Heeren, professor of biostatistics, and Gregory Patts, statistical manager of the Data Coordinating Center. Co-authors from the School of Medicine and Boston Medical Center include: Alexander Walley, Alicia Ventura, Jeffrey Samet, and Meg Sullivan.
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