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The Longitudinal Effects of Non-injection Substance Use on Sustained HIV Viral Load Undetectability Among MSM and Heterosexual Men in Brazil and Thailand: The Role of ART Adherence and Depressive Symptoms (HPTN 063)

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Abstract

The effect of non-injection substance use on HIV viral load (VL) is understudied in international settings. Data are from HPTN063, a longitudinal observational study of HIV-infected individuals in Brazil, Thailand, and Zambia, with focus on men with VL data (Brazil = 146; Thailand = 159). Generalized linear mixed models (GLMM) assessed whether non-injection substance use (stimulants, cannabis, alcohol, polysubstance) was associated with VL undetectability. ART adherence and depressive symptoms were examined as mediators of the association. In Thailand, substance use was not significantly associated with VL undetectability or ART adherence, but alcohol misuse among MSM was associated with increased odds of depression (AOR = 2.75; 95% CI 1.20, 6.32, p = 0.02). In Brazil, alcohol misuse by MSM was associated with decreased odds of undetectable VL (AOR = 0.34; 95% CI 0.13, 0.92, p = 0.03). Polysubstance use by heterosexual men in Brazil was associated with decreased odds of ART adherence (AOR = 0.25; 95% CI 0.08, 0.78, p = 0.02). VL suppression appears attainable among non-injection substance users. Substance use interventions among HIV-positive men should address depression, adherence, and VL undetectability.

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References

  1. Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.

    Article  PubMed  PubMed Central  Google Scholar 

  2. WHO. Antiretroviral treatment as prevention (TASP) of HIV and TB. 2012.

  3. Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;11(365):469–505.

    Google Scholar 

  4. Günthard HF, Saag MS, Benson CA, Del Rio C, Eron JJ, Gallant JE, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the International Antiviral Society—USA panel. JAMA. 2016;316(2):191–210.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Shoptaw S, Montgomery B, Williams CT, El-Bassel N, Aramrattana A, Metzger DS, et al. Not just the needle: the state of HIV prevention science among substance users and future directions. J Acquir Immune Defic Syndr. 1999;2013(63):S174.

    Google Scholar 

  6. Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep. 2011;8(4):223.

    Article  PubMed  Google Scholar 

  7. Bogart LM, Kelly JA, Catz SL, Sosman JM. Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. JAIDS J Acquir Immune Defic Syndr. 2000;23(5):396–404.

    Article  CAS  PubMed  Google Scholar 

  8. Cofrancesco J Jr, Scherzer R, Tien PC, Gibert CL, Southwell H, Sidney S, et al. Illicit drug use and HIV treatment outcomes in a US cohort. AIDS (London, England). 2008;22(3):357.

    Article  PubMed Central  Google Scholar 

  9. Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. JAIDS J Acquir Immune Defic Syndr. 2001;27(3):251–9.

    Article  CAS  PubMed  Google Scholar 

  10. McGowan CC, Weinstein DD, Samenow CP, Stinnette SE, Barkanic G, Rebeiro PF, et al. Drug use and receipt of highly active antiretroviral therapy among HIV-infected persons in two US clinic cohorts. PLoS ONE. 2011;6(4):e18462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Arnsten JH, Demas PA, Grant RW, Gourevitch MN, Farzadegan H, Howard AA, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in hiv-infected drug users. J Gen Intern Med. 2002;17(5):377–81.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hinkin CH, Barclay TR, Castellon SA, Levine AJ, Durvasula RS, Marion SD, et al. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11(2):185–94.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3(11):2039–64.

    Article  Google Scholar 

  14. Wilson IB, Carter AE, Berg KM. Improving the self-report of HIV antiretroviral medication adherence: is the glass half full or half empty? Curr HIV/AIDS Rep. 2009;6(4):177–86.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Carrico AW. Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV. Life Sci. 2011;88(21):940–7.

    Article  CAS  PubMed  Google Scholar 

  16. Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, et al. Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of anti-retroviral therapy utilization. J Acquir Immune Defic Syndr. 2011;56(2):146.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ellis RJ, Childers ME, Cherner M, Lazzaretto D, Letendre S, Grant I, et al. Increased human immunodeficiency virus loads in active methamphetamine users are explained by reduced effectiveness of antiretroviral therapy. J Infect Dis. 2003;188:1820–6.

    Article  PubMed  Google Scholar 

  18. Cook JA, Burke-Miller JK, Cohen MH, Cook RL, Vlahov D, Wilson TE, et al. Crack cocaine, disease progression, and mortality in a multi-center cohort of HIV-1 positive women. AIDS (London, England). 2008;22(11):1355.

    Article  CAS  PubMed Central  Google Scholar 

  19. Morin SF, Myers JJ, Shade SB, Koester K, Maiorana A, Rose CD. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav. 2007;11(1):6–16.

    Article  Google Scholar 

  20. Parsons JT, Bimbi DS. Intentional unprotected anal intercourse among sex who have sex with men: barebacking—from behavior to identity. AIDS Behav. 2007;11(2):277–87.

    Article  PubMed  Google Scholar 

  21. Rasbach DA, Desruisseau AJ, Kipp AM, Stinnette S, Kheshti A, Shepherd BE, et al. 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. AIDS care. 2013;25(1):109–17.

    Article  PubMed  Google Scholar 

  22. Bagasra O, Pomerantz RJ. Human immunodeficiency virus type 1 replication in peripheral blood mononuclear cells in the presence of cocaine. J Infect Dis. 1993;168(5):1157–64.

    Article  CAS  PubMed  Google Scholar 

  23. Cabral GA. Drugs of abuse, immune modulation, and AIDS. J Neuroimmune Pharmacol. 2006;1(3):280–95.

    Article  PubMed  Google Scholar 

  24. Nair MP, Chadha KC, Hewitt RG, Mahajan S, Sweet A, Schwartz SA. Cocaine differentially modulates chemokine production by mononuclear cells from normal donors and human immunodeficiency virus type 1-infected patients. Clin Diagn Lab Immunol. 2000;7(1):96–100.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Tashkin DP. Evidence implicating cocaine as a possible risk factor for HIV infection. J Neuroimmunol. 2004;147(1):26–7.

    Article  CAS  PubMed  Google Scholar 

  26. Hasin D, Kilcoyne B. Comorbidity of psychiatric and substance use disorders in the United States: current issues and findings from the NESARC. Curr Opin Psychiatry. 2012;25(3):165.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.

    Article  CAS  PubMed  Google Scholar 

  28. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.

    Article  CAS  PubMed  Google Scholar 

  29. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011. https://doi.org/10.1097/QAI.0b013e31822d490a.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539–45.

    Article  PubMed  Google Scholar 

  31. Antoni MH, Carrico AW, Durán RE, Spitzer S, Penedo F, Ironson G, et al. Randomized clinical trial of cognitive behavioral stress management on human immunodeficiency virus viral load in gay men treated with highly active antiretroviral therapy. Psychosom Med. 2006;68(1):143–51.

    Article  PubMed  Google Scholar 

  32. Rosen M, Black A, Arnsten J, Goggin K, Remien R, Simoni J, et al. Association between use of specific drugs and antiretroviral adherence: findings from MACH 14. AIDS Behav. 2013;17(1):142–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Reback CJ, Larkins S, Shoptaw S. Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care. 2003;15(6):775–85.

    Article  CAS  PubMed  Google Scholar 

  34. Feelemyer J, Des Jarlais D, Arasteh K, Uusküla A. Adherence to antiretroviral medications among persons who inject drugs in transitional, low and middle income countries: an international systematic review. AIDS Behav. 2015;19(4):575–83.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hatzenbuehler ML, Nolen-Hoeksema S, Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men. Health Psychol. 2008;27(4):455.

    Article  PubMed  Google Scholar 

  36. Thai National AIDS Committee. Thailand ending AIDS: 2014 Thailand AIDS response progress report. 2014.

  37. UNAIDS Global AIDS Response Report. The Brazilian Response to HIV and AIDS (2015). Brasilia, D.F.

  38. Departamento de DST Aids e Hepatites Virais. AIDS in Brazil: Brazilian Policy Focus. Brasilia; 2012 July 2012.

  39. MacCarthy S, Brignol S, Reddy M, Nunn A, Dourado I. Late presentation to HIV/AIDS care in Brazil among men who self-identify as heterosexual. Rev de Saude Publ. 2016;50:54.

    Article  Google Scholar 

  40. Tsuyuki K, Pitpitan EV, Levi-Minzi MA, Urada LA, Kurtz SP, Stockman JK, et al. Substance use disorders, violence, mental health, and HIV: differentiating a syndemic factor by gender and sexuality. AIDS Behav. 2017;21:1–13.

    Article  Google Scholar 

  41. Fendrich M, Avci O, Johnson TP, Mackesy-Amiti ME. Depression, substance use and HIV risk in a probability sample of men who have sex with men. Addict Behav. 2013;38(3):1715–8.

    Article  PubMed  Google Scholar 

  42. Safren SA, Hughes JP, Mimiaga MJ, Moore AT, Friedman RK, Srithanaviboonchai K, et al. Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents. J Int AIDS Soc. 2016;19(1):21096.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Magidson JF, Li X, Mimiaga MJ, Moore AT, Srithanaviboonchai K, Friedman RK, et al. Antiretroviral medication adherence and amplified HIV transmission risk among sexually active HIV-infected individuals in three diverse international settings. AIDS Behav. 2015;20:1–11.

    Google Scholar 

  44. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–95.

    Article  CAS  PubMed  Google Scholar 

  45. Radloff L. The CES-D scale: a self-report depression scale for researchers in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  46. Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12(1):86–94.

    Article  PubMed  Google Scholar 

  47. Feldman B, Fredericksen R, Crane P, Safren S, Mugavero M, Willig JH, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2013;17(1):307–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Hedeker D. Generalized linear mixed models. Encyclopedia of statistics in behavioral science. 2005. p. 1-10.

  49. Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL. The impact of alcohol use and related disorders on the HIV continuum of care: a systematic review. Curr HIV/AIDS Rep. 2015;12(4):421–36.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hahn JA, Samet JH. Alcohol and HIV disease progression: weighing the evidence. Curr HIV/AIDS Rep. 2010;7(4):226–33.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kahler CW, Liu T, Cioe PA, Bryant V, Pinkston MM, Kojic EM, et al. Direct and indirect effects of heavy alcohol use on clinical outcomes in a longitudinal study of HIV patients on ART. AIDS Behav. 2016;21:1–11.

    Google Scholar 

  52. Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retroviruses. 2010;26(5):511–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Lake S, Kerr T, Capler R, Shoveller J, Montaner J, Milloy M-J. High-intensity cannabis use and HIV clinical outcomes among HIV-positive people who use illicit drugs in Vancouver, Canada. Int J Drug Policy. 2017;42:63–70.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Strathdee SA, Stockman JK. Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions. Curr HIV/AIDS Rep. 2010;7(2):99–106.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Patterson TL, Semple SJ, Zians JK, Strathdee SA. Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use. J Urban Health. 2005;82(1):i120–6.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Carrico AW, Zepf R, Meanley S, Batchelder A, Stall R. Critical review: when the party is over: A systematic review of behavioral interventions for substance-using men who have sex with men. JAIDS J Acquir Immune Defic Syndr. 2016;73(3):299–306.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Steve Shoptaw as HPTN Scholar mentor (P30 MH058107); HPTN 063 Study Participants and Protocol Team Members; the Fred Hutchinson Cancer Research Center; and Noor A. Al-Alusi for her help designing the manuscript’s figure. This study was supported by NIAID, NIDA, and NIMH under cooperative agreement #UM1 AI068619 as part of the HPTN Scholars Program. Dr. Kiyomi Tsuyuki was supported by NIDA (T32 DA023356); NICHD (R01 HD077891-04S1); and NIAAA (K01AA025009); Dr. Yusuf Ransome supported by NIMH (K01MH111374); Dr. Steven A. Safren was supported by NIDA (9K24DA040489). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the HIV Prevention Trials Network.

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Authors and Affiliations

  1. Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (UCSD), 9500 Gilman Drive, MC 0507, La Jolla, San Diego, CA, 92093-0507, USA

    Kiyomi Tsuyuki

  2. David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA

    Steven J. Shoptaw

  3. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Yusuf Ransome

  4. Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Gordon Chau & Sue Li

  5. University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico

    Carlos E. Rodriguez-Diaz

  6. Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil

    Ruth K. Friedman

  7. Faculty of Medicine, Chiang Mai University, Muang District, Chiang Mai, Thailand

    Kriengkrai Srithanaviboonchai

  8. Research Institute for Health Sciences, Chiang Mai University, Muang District, Chiang Mai, Thailand

    Kriengkrai Srithanaviboonchai

  9. Center for Health Equity Research, Brown University, Providence, RI, USA

    Matthew J. Mimiaga

  10. The Fenway Institute, Fenway Health, Boston, MA, USA

    Kenneth H. Mayer

  11. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Steven A. Safren

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  1. Kiyomi Tsuyuki
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Correspondence to Kiyomi Tsuyuki.

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Ethical considerations reviewed and approved by institutional review boards (IRB) within each recruitment country. Informed consent was obtained from all individual participants included in the study prior to interview.

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Tsuyuki, K., Shoptaw, S.J., Ransome, Y. et al. The Longitudinal Effects of Non-injection Substance Use on Sustained HIV Viral Load Undetectability Among MSM and Heterosexual Men in Brazil and Thailand: The Role of ART Adherence and Depressive Symptoms (HPTN 063). AIDS Behav 23, 649–660 (2019). https://doi.org/10.1007/s10461-019-02415-w

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