Nolan Seonaid, Walley Alexander Y, Heeren Timothy C, Patts Gregory J, Ventura Alicia S, Sullivan Meg M, Samet Jeffrey H, Saitz Richard
a Department of Medicine , University of British Columbia, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.
b Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA.
AIDS Care. 2017 Sep;29(9):1129-1136. doi: 10.1080/09540121.2017.1327646. Epub 2017 May 17.
People living with HIV (PLWH) on antiretroviral therapy (ART) who use substances were examined to (a) describe those with virologic control and (b) determine which substance use-factors are associated with lack of virologic control. Participants were adult PLWH taking ART with either past 12-month DSM-IV substance dependence or past 30-day alcohol or illicit drug use. Substance use factors included number of DSM-IV alcohol or drug dependence criteria and past 30-day specific substance use. Associations with HIV viral load (HVL) (<200 vs. ≥200 copies/mL) were tested using logistic regression models. Multivariable analyses adjusted for age, sex, homelessness and anxiety or depression. Participants (n = 202) were median age 50 years, 66% male, 51% African American and 75% self-reported ≥90% past 30-day ART adherence. Though HVL suppression (HVL <200 copies/mL) was achieved in 78% (158/202), past 30-day substance use was common among this group: 77% cigarette use; 51% heavy alcohol use; 50% marijuana; 27% cocaine; 16% heroin; and 15% illicit prescription opioid use. After adjusting for covariates, specific substance use was not associated with a detectable HVL, however number of past 12-month DSM-IV drug dependence criteria was (adjusted odds ratio = 1.23 for each additional criterion, 95% CI: 1.04-1.46). Three-quarters of a substance-using cohort of PLWH receiving ART had virologic control and ≥90% ART adherence. Substance dependence criteria (particularly drug dependence), not specifically substance use, were associated with lack of virologic control. Optimal HIV outcomes can be achieved by individuals who use alcohol or drugs and addressing symptoms of substance dependence may improve HIV-related outcomes.
对接受抗逆转录病毒治疗（ART）且使用药物的艾滋病毒感染者（PLWH）进行了研究，以（a）描述病毒学得到控制的感染者，以及（b）确定哪些药物使用因素与病毒学未得到控制有关。参与者为成年PLWH，他们正在接受ART治疗，且在过去12个月内符合《精神疾病诊断与统计手册》第四版（DSM-IV）的药物依赖标准，或在过去30天内有酒精或非法药物使用情况。药物使用因素包括DSM-IV酒精或药物依赖标准的数量以及过去30天内特定药物的使用情况。使用逻辑回归模型测试与艾滋病毒病毒载量（HVL）（<200与≥200拷贝/毫升）的关联。多变量分析对年龄、性别、无家可归状态以及焦虑或抑郁进行了校正。参与者（n = 202）的年龄中位数为50岁，66%为男性，51%为非裔美国人，75%自我报告在过去30天内ART依从性≥90%。尽管78%（158/202）的参与者实现了HVL抑制（HVL<200拷贝/毫升），但在这组人群中过去30天内使用药物的情况很常见：77%吸烟；51%大量饮酒；50%使用大麻；27%使用可卡因；16%使用海洛因；15%使用非法处方阿片类药物。在对协变量进行校正后，特定药物的使用与可检测到的HVL无关，然而过去12个月内DSM-IV药物依赖标准的数量与HVL有关（每增加一条标准，校正比值比 = 1.23，95%置信区间：1.04 - 1.46）。接受ART治疗的使用药物的PLWH队列中有四分之三实现了病毒学控制且ART依从性≥90%。药物依赖标准（特别是药物依赖）而非特定的药物使用与病毒学未得到控制有关。使用酒精或药物的个体可以实现最佳的艾滋病毒治疗效果，解决药物依赖症状可能会改善与艾滋病毒相关的治疗效果。
