by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

April 25, 2019

Featured Literature:

Nance Robin M et al. Impact of abstinence and of reducing illicit drug use without abstinence on HIV viral load. Clinical Infectious Diseases, Published online: April 17, 2019

Substance use is very common among people living with HIV (PLWH) and many studies have found it to be a barrier to engaging in care, adherence to ART, maintaining viral suppression, and retention in care. This was an observational study that included PLWH from the Centers for AIDS Research Network of Integrated Clinical Sites (CNICS) and from the Criminal Justice Seek, Test, Treat, and Retain (STTR) collaboration. These two cohorts represented 8 separated HIV clinics. The authors used both longitudinal and survival models to assess the impact of abstinence and decreasing drug use (illicit opioids, methamphetamine, cocaine, and marijuana) on viral suppression. The number of subjects using each drug at baseline ranged from 568 (opioids) to 4272 (marijuana). Abstinence from drug use was associated with higher odds of viral suppression (OR 1.4 to 2.2) and lower relative viral load (ranging from 21 – 42%) for all four drug categories. Reducing the frequency of illicit opioid or crystal methamphetamine use without abstinence was also associated with viral load suppression (OR of 2.2 and 1.6 respectively). Reducing the frequency of the two substances was also associated with lower relative viral load (47% and 38% respectively). The authors note their study shows that abstinence from illicit drugs is directly associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. The data support the impact of reducing substance use even when abstinence is not achieved and the benefits of harm reduction and behavioral interventions.

Commentary: These data should not be surprising for clinicians who work in HIV medicine. It is important to know that helping our patients reduce drug use (while working towards abstinence) through various interventions such as 12-step meetings, counseling, and medically assisted treatment can lead to better clinical outcomes base on viral load suppression.

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