Edward R. Cachay , Tesfaye S. Moges , Huifang Qin , Laura Bamford , David J. Grelotti , Wm. Christopher Mathews
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引用次数: 0
Abstract
Objectives
People living with HIV (PWH) with substance or alcohol use often have unsuppressed plasma HIV viral loads (pVL). The degree to which substance and alcohol use effects on HIV viral suppression are mediated through medication nonadherence is incompletely understood.
Methods
We included PWH prescribed antiretroviral therapy and receiving care at an academic HIV clinic between 2014 and 2018 who completed both patient-reported outcomes (PRO) questionnaires and had subsequent pVL measurements. Measures included assessments of alcohol use (AUDIT-C), drug use (NIDA-ASSIST), and self-reported adherence measured using four different methods. Substances found in bivariate analysis to predict detectable pVL were modeled separately for mediation effects through adherence. We report natural direct (NDE) and indirect effect (NIE), marginal total effect (MTE), and percentage mediated.
Results
Among 3125 PWH who met eligibility criteria, 25.8% reported hazardous alcohol use, 27.1% cannabis, 13.1% amphetamines, 1.9% inhalants, 5.3% cocaine, 4.5% sedative-hypnotics, 2.9% opioids, and 2.3% hallucinogens. Excellent adherence was reported by 58% of PWH, and 10% had detectable pVL. Except for sedatives, using other substances was significantly associated with worse adherence. Bivariate predictors of detectable pVL were [OR (95% CI)]: amphetamine use 2.4 (1.8–3.2) and opioid use 2.3 (1.3–4.0). The percent of marginal total effect mediated by nonadherence varied by substance: 36% for amphetamine use, 27% for opioid use, and 39% for polysubstance use.
Conclusion
Use of amphetamines, opioids, and multiple substances predicted detectable pVL. Up to 40% of their effects were mediated by self-reported nonadherence. Confirmation using longitudinal measurement models will strengthen causal inference from this cross-sectional analysis.
期刊介绍:
Addictive Behaviors Reports is an open-access and peer reviewed online-only journal offering an interdisciplinary forum for the publication of research in addictive behaviors. The journal accepts submissions that are scientifically sound on all forms of addictive behavior (alcohol, drugs, gambling, Internet, nicotine and technology) with a primary focus on behavioral and psychosocial research. The emphasis of the journal is primarily empirical. That is, sound experimental design combined with valid, reliable assessment and evaluation procedures are a requisite for acceptance. We are particularly interested in ''non-traditional'', innovative and empirically oriented research such as negative/null data papers, replication studies, case reports on novel treatments, and cross-cultural research. Studies that might encourage new lines of inquiry as well as scholarly commentaries on topical issues, systematic reviews, and mini reviews are also very much encouraged. We also welcome multimedia submissions that incorporate video or audio components to better display methodology or findings.