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)

  • Kiyomi TsuyukiEmail author
  • Steven J. Shoptaw
  • Yusuf Ransome
  • Gordon Chau
  • Carlos E. Rodriguez-Diaz
  • Ruth K. Friedman
  • Kriengkrai Srithanaviboonchai
  • Sue Li
  • Matthew J. Mimiaga
  • Kenneth H. Mayer
  • Steven A. Safren
Original Paper


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.


Substance use HIV Depression Adherence Undetectable viral load 



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.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kiyomi Tsuyuki
    • 1
    Email author
  • Steven J. Shoptaw
    • 2
  • Yusuf Ransome
    • 3
  • Gordon Chau
    • 4
  • Carlos E. Rodriguez-Diaz
    • 5
  • Ruth K. Friedman
    • 6
  • Kriengkrai Srithanaviboonchai
    • 7
    • 8
  • Sue Li
    • 4
  • Matthew J. Mimiaga
    • 9
  • Kenneth H. Mayer
    • 10
  • Steven A. Safren
    • 11
  1. 1.Division of Infectious Diseases and Global Public Health, Department of MedicineUniversity of California, San Diego (UCSD)San DiegoUSA
  2. 2.David Geffen School of Medicine, Department of Family MedicineUniversity of California, Los Angeles (UCLA)Los AngelesUSA
  3. 3.Harvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Statistical Center for HIV/AIDS Research and Prevention (SCHARP)Fred Hutchinson Cancer Research CenterSeattleUSA
  5. 5.University of Puerto RicoSan JuanPuerto Rico
  6. 6.Instituto de Pesquisa Clinica Evandro ChagasRio de JaneiroBrazil
  7. 7.Faculty of MedicineChiang Mai UniversityChiang MaiThailand
  8. 8.Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
  9. 9.Center for Health Equity ResearchBrown UniversityProvidenceUSA
  10. 10.The Fenway Institute, Fenway HealthBostonUSA
  11. 11.Department of PsychologyUniversity of MiamiCoral GablesUSA

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