Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era

Jimmy Ma; Joseph A C Delaney; Stephanie A Ruderman; Robin M Nance; Andrew W Hahn; Lydia N Drumright; Bridget M Whitney; Rob J Fredericksen; L Sarah Mixson; Joseph O Merrill; Steven A Safren; Kenneth H Mayer; Conall O'Cleirigh; Sonia Napravnik; Geetanjali Chander; Richard D Moore; Katerina A Christopoulos; Amanda L Willig; Laura Bamford; Allison Webel; Mary E McCaul; Edward R Cachay; Jeffrey M Jacobson; Michael S Saag; Mari M Kitahata; Heidi M Crane; Emily C Williams

doi:10.1007/s10461-024-04532-7

Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era

AIDS Behav. 2024 Oct 28. doi: 10.1007/s10461-024-04532-7. Online ahead of print.

Authors

Jimmy Ma¹, Joseph A C Delaney^{2

3}, Stephanie A Ruderman^{2

4}, Robin M Nance², Andrew W Hahn², Lydia N Drumright^{2

5}, Bridget M Whitney², Rob J Fredericksen², L Sarah Mixson², Joseph O Merrill², Steven A Safren⁶, Kenneth H Mayer⁷, Conall O'Cleirigh^{7

8}, Sonia Napravnik^{9

10}, Geetanjali Chander², Richard D Moore¹¹, Katerina A Christopoulos¹², Amanda L Willig¹³, Laura Bamford¹⁴, Allison Webel¹⁵, Mary E McCaul¹⁶, Edward R Cachay^{12

14}, Jeffrey M Jacobson¹⁷, Michael S Saag¹³, Mari M Kitahata², Heidi M Crane², Emily C Williams^{18

19}

Affiliations

¹ Department of Medicine, University of Washington, Seattle, WA, USA. jma52@uw.edu.
² Department of Medicine, University of Washington, Seattle, WA, USA.
³ College of Pharmacy, University of Manitoba, Winnipeg, Canada.
⁴ Department of Epidemiology, University of Washington, Seattle, WA, USA.
⁵ Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA.
⁶ Department of Psychology, University of Miami, Coral Gables, FL, USA.
⁷ The Fenway Institute, Fenway Health, and Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
⁸ Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
⁹ Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
¹⁰ Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
¹¹ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
¹² Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹³ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁴ Department of Medicine, University of California, San Diego, San Diego, CA, USA.
¹⁵ Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA.
¹⁶ Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
¹⁸ Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
¹⁹ Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA.

PMID: 39465466
DOI: 10.1007/s10461-024-04532-7

Abstract

Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care. Among 10,557 PWH (2010-2021) from 8 academic clinical sites nationally we examined longitudinal associations of substance use severity and number of substances used (measured using AUDIT-C and modified ASSIST) with patient-reported ART adherence (visual analog scale). Alcohol (68% any use, 18% unhealthy use [AUDIT-C > 4 men, > 3 women]), marijuana (33%), and methamphetamine (9%) use were most reported. Polysubstance use was common (32%). Both higher severity substance use and higher number of substances used were associated with lower ART adherence. Severity of methamphetamine use had the strongest dose-response association with ART adherence (low severity [ASSIST 1-3]: -3.05%, 95% CI: -4.23%, -1.87%; moderate [ASSIST 4-26]: -6.20%, 95% CI: -7.08%, -5.33%; high [ASSIST > 26]: -10.77%, 95% CI: -12.76%, -8.78%). Severe substance use, especially methamphetamine, and higher number of illicit drugs used were associated with declines in adherence at levels that were likely clinically meaningful in the modern era of ART. Findings support integrating substance use care with HIV care and potential benefits of harm reduction strategies for improving adherence such as encouraging lower levels of substance use and fewer number of substances used.

Keywords: ART; Adherence; Antiretroviral Therapy; Methamphetamine; Substance use.

Abstract

Grants and funding