Continued Substance Use Among People Living With HIV–Hepatitis-C Co-Infection and Receiving Antiretroviral Therapy

Abstract

Background: Co-infection with human immunodeficiency virus (HIV) and Hepatitis-C virus (HCV) poses a significant threat to personal and public health. Substance use among co-infected persons leads to increased morbidity and mortality. The purpose of this study is to examine the continued substance use of people living with HIV–HCV co-infection and receiving antiretroviral therapy (ART). Methods: Individuals living with HIV infection in Atlanta, GA and currently receiving ART (N = 678) completed audio-computer-assisted self-interviews for demographic, health, and behavior characteristics; unannounced pill counts to assess ART adherence over one month; finger-stick blood specimens collected for HCV antibody testing and urine specimens for drug use screening; and obtained HIV viral load and CD4 cell counts from their medical provider. We performed cross-sectional analyses for behavioral and biological markers of health, health behaviors, and substance use. Results: Among participants, 131 (19%) were HIV–HCV co-infected; 53% were HIV-mono-infected, and 60% of HIV–HCV co-infected participants tested positive for use of at least one non-alcohol drug: tetrahydrocannabinol (THC) and cocaine were most prevalent. HIV–HCV co-infected individuals were older, with no other significant differences. Within the HIV–HCV co-infected participants, drug users (N = 87) did not differ from non-drug users (N = 53) in terms of ART adherence. However, drug users were significantly more likely to have uncontrolled HIV (17%) compared with those who did not test drug positive (4%). Conclusions: Substance use is prevalent in persons with HIV–HCV co-infection and may interfere with ART. Research with a larger and more representative sample is needed to replicate and confirm these results.

Keywords :

• HIV/AIDS, Hepatitis-C, HIV-HCV co-infection, comorbidity

THE AUTHORS

Seth C. Kalichman is a professor of psychology at the University of Connecticut. His research focuses on social and behavioral aspects of AIDS, particularly sexual risk behavior intervention and medication adherence research in the southeastern US and South Africa.

Christopher Washington, Christopher Kegler, and Tamar Grebler are research associates with the University of Connecticut, working exclusively on studies of HIV prevention, treatment, and care in the southern US and South Africa.

Moira O. Kalichman and Chauncey Cherry are program managers at the University of Connecticut. They have dedicated their careers to conducting social and behavioral research with underserved populations affected with HIV/AIDS.

Lisa Eaton is an assistant professor of human development and family studies at the University of Connecticut. Her research is focused on improving the health of underserved and understudied populations. Her current research is developing behavioral interventions to reduce HIV transmission risks and increase HIV testing access among men who have sex with men.

GLOSSARY

• Adherence: The ratio of pills counted relative to pills prescribed, taking into account the number of pills dispensed.

• ART: Antiretroviral therapies, medications used for treating HIV infection.

• Co-infection: In this study, dually diagnosed with HIV infection and hepatitis-C virus infection.

• HIV RNA: The genetic material of HIV.

• Viral load: Refers to a measure of active virus in a given unit of a body fluid; e.g., the amount of HIV RNA in a standard unit of blood plasma.