Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era

ABSTRACT

Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.

KEYWORDS:

• Substance use
• methamphetamine
• alcohol
• antiretroviral therapy
• ART
• adherence

Acknowledgements

The authors would like to thank the participants, other investigators, and staff involved with the Centers for AIDS Research Network of Integrated Clinical Sites study (www.uab.edu/cnics) for their contributions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institute of Allergy and Infectious Diseases: [Grant Number P30AI027757, P30AI027763, P30AI027767, P30AI036214, P30AI036219, P30AI060354, P30AI094189, P30AI50410, R24AI067039, U01DA036935]; National Institute of Mental Health: [Grant Number 1P30MH116867]; National Institute on Alcohol Abuse and Alcoholism: [Grant Number U01AA020793, U01AA020802, U24AA020801]; National Institute on Drug Abuse: [Grant Number R01DA047045, U01DA036935]; National Institutes of Health: [Grant Number T32 AI 7044-46].