Active cocaine use is associated with lack of HIV-1 virologic suppression independent of nonadherence to antiretroviral therapy: Use of a rapid screening tool during routine clinic visits

Abstract

Clarifying the relationship between illicit drug use and HIV-1 virologic suppression requires characterization of both illicit drug use activity and adherence to antiretroviral therapy (ART). We developed a rapid clinical questionnaire to assess prior 7-day illicit drug use and ART adherence in a cross-sectional study among 1777 HIV-infected persons in care. Of these, 76% were male, 35% were African-American, and 8% reported injection drug use as their probable route of HIV-1 infection. Questionnaire-reported frequencies of cocaine and marijuana use within the previous 7 days were 3.3% and 12.1%, respectively. Over three quarters (77.8%) of participants were on ART, of whom 69.7% had HIV-1 virologic suppression (HIV-1 RNA<48 copies/mL). Univariate analyses revealed that compared to no use, cocaine and marijuana use were both associated with missed ART doses (P<0.01). Multivariable logistic regression analysis adjusting for nonadherence demonstrated that cocaine use was independently associated with failing to achieve virologic suppression (adjusted odds ratio (aOR): 0.46; 95% confidence interval (95% CI): 0.22–0.98) but marijuana use was not (aOR: 1.08; 95% CI: 0.72–1.62). This result strengthens the evidence of a direct effect of cocaine on virologic control, independent of nonadherence to ART.

Keywords:

• drug use
• cocaine
• marijuana
• antiretroviral therapy
• HIV-1 virologic suppression

Acknowledgements

The authors would like to thank the Comprehensive Care Center and its patients and medical providers, as well as the Vanderbilt Epidemiology and Outcomes Group for contributions to study design and interpretation of results. This research was supported by National Institutes of Health grants P30 AI54999-09 and K24 AI065298.

Additional information

Notes on contributors

Andrew J. Desruisseau

Daniel A. Rasbach and Andrew J. Desruisseau contributed equally to this work