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Substance Use and its Association with Psychiatric Symptoms in Perinatally HIV-infected and HIV-Affected Adolescents

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Abstract

Drug use in combination with psychiatric illness may lead to unsafe sexual risk behavior and increased risk for secondary HIV transmission among adolescents with HIV infection. We compared the prevalence of substance use for perinatally HIV-infected youth to uninfected adolescents living in families affected by HIV infection, and evaluated the association of psychiatric symptoms with risk of substance use. Among 299 adolescents (196 HIV+, 103 HIV−) aged 12–18 years enrolled in IMPAACT P1055, a multisite US cohort study, 14% reported substance use at enrollment (HIV+: 13%, HIV−: 16%). In adjusted logistic regression models, adolescents had significantly higher odds of substance use if they met symptom criteria for ADHD [adjusted odds ratio (aOR) = 2.7, Wald χ2 = 5.18, P = 0.02], major depression or dysthymia (aOR = 4.0, Wald χ2 = 7.36, P = 0.01), oppositional defiant disorder (aOR = 4.8, Wald χ2 = 12.7, P = 0.001), or conduct disorder (aOR = 15.4, Wald χ2 = 28.12, P = 0.001). Among HIV-infected youth, those with lower CD4 lymphocyte percentage (CD4% < 25%) had significantly increased risk of substance use (aOR = 2.7, Wald χ2 = 4.79, P = 0.03). However, there was no overall association of substance use with HIV infection status, and the association between psychiatric symptoms and substance use did not differ by HIV status. Programs to prevent substance use should target both HIV-infected and uninfected adolescents living in families affected by HIV infection, particularly those with psychiatric symptoms.

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Acknowledgments

We would like to thank Kimberly Hudgens for her operational support of this study and Janice Hodge for data management. We express our gratitude for Dr. Pim Brouwers’ guidance on this project and his extensive scientific expertise regarding psychiatric conditions in relation to perinatal HIV. We also acknowledge with great appreciation the help given by Nagamah Sandra Deygoo in representing the site research staff on the protocol team. Finally, we thank the institutions and site staff who enrolled participants to IMPAACT P1055, as listed in Appendix. The trial sponsors are National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Mental Health (NIMH), and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Funding

Overall support for the IMPAACT Group was provided by the National Institute of Allergy and Infectious Diseases [U01 AI068632] and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Mental Health (NIMH). These institutions were involved in the design, data collection and conduct of P1055, but were not involved in the present analysis, the interpretation of the data, the writing of the manuscript, or the decision to submit for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was supported by the Statistical and Data Analysis Center at Harvard School of Public Health, under the National Institute of Allergy and Infectious Diseases cooperative agreement #1 U01 AI-41110 with the Pediatric AIDS Clinical Trials Group (PACTG) and #1 U01 AI068616 with the IMPAACT Group. Support of the sites was provided by the NIAID and the NICHD International and Domestic Pediatric and Maternal HIV Clinical Trials Network funded by NICHD (contract number N01-DK-9-001/HHSN267200800001C).

Author information

Authors and Affiliations

  1. Center for Biostatistics in AIDS Research, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA

    Paige L. Williams, Erin Leister & Miriam Chernoff

  2. Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA, USA

    Paige L. Williams

  3. Department of Pediatrics, Stony Brook University, Stony Brook, NY, USA

    Sharon Nachman

  4. Tulane University Health Sciences Center, New Orleans, LA, USA

    Edward Morse

  5. Robert Wood Johnson University Hospital, Hazlet, NJ, USA

    Vinnie Di Poalo

  6. Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY, USA

    Kenneth D. Gadow

Authors
  1. Paige L. Williams
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  2. Erin Leister
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  3. Miriam Chernoff
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  4. Sharon Nachman
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  5. Edward Morse
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  6. Vinnie Di Poalo
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  7. Kenneth D. Gadow
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Corresponding author

Correspondence to Paige L. Williams.

Additional information

This study was conducted for the IMPAACT 1055 Team. The institutions and the site staff who enrolled participants to IMPAACT P1055, are listed in Appendix.

Appendix

Appendix

Institutions and site staff who enrolled participants to the study IMPAACT P1055, conducted by the International Maternal Pediatric and Adolescent AIDS Clinical Trials (IMPAACT) group:

Children’s Hospital Boston, Div. of Infectious Diseases: S Burchett; UCLA-Los Angeles/Brazil AIDS Consortium: K Nielsen, N Falgout, J Geffen, JG Deville; Long Beach Memorial Medical Center, Miller Children’s Hospital: A Deveikis; Harbor—UCLA Medical Center—Dept. of Peds, Div. of Infectious Diseases: M Keller; Univ. of Maryland Med. Ctr., Div. of Ped. Immunology & Rheumatology: V Tepper; Chicago Children’s: R Yogev; UCSF Pediatric AIDS CRS: D Wara; UCSD Maternal, Child, and Adolescent HIV: SA Spector, L Stangl, M Caffery, R Viani; DUMC Ped; K Whitfield, S Patil, J Wilson, MJ Hassett; New York University: S Deygoo, W Borkowsky, S Chandwani, M Rigaud; Jacobi Medical Center Bronx: A Wiznia; Univ. of Washington Children’s Hosp. Seattle; L Frenkel; USF—Tampa: P Emmanuel, J Zilberman, C Rodriguez, C Graisbery; Mount Sinai School of Medicine, NY: R Posada, MS Dolan; San Juan City Hospital: M Acevedo-Flores, L Angeli, M Gonzalez, D Guzman; Yale Univ. School of Medicine—Dept. of Peds., Div. of Infectious Disease: WA Andiman, L Hurst, A Murphy; SUNY Upstate Med. Univ., Dept. of Peds: L Weiner; SUNY Stony Brook: D Ferraro, M Kelly, L Rubino; Howard Univ. Washington DC: S Rana; University of Southern California: S Kapetanovic; Univ. of Florida Jacksonville: MH Rathore, A Mirza, K Thoma, C Griggs; Univ. of Colorado Denver: R McEvoy, E Barr, S Paul, P Michalek; South Florida CDC Ft Lauderdale: A Puga; St. Jude/UTHSC: P Garvie; The Children’s Hosp. of Philadelphia: R Rutstein; St. Christopher’s Hosp. for Children: R LaGuerre; Bronx-Lebanon Hospital: M Purswani; Metropolitan Hospital Center: M Bamji; WNE Maternal Pediatric Adolescent AIDS: K Luzuriaga.

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Williams, P.L., Leister, E., Chernoff, M. et al. Substance Use and its Association with Psychiatric Symptoms in Perinatally HIV-infected and HIV-Affected Adolescents. AIDS Behav 14, 1072–1082 (2010). https://doi.org/10.1007/s10461-010-9782-0

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