在因 HIV 感染控制不佳而住院的物质使用个体中，大量饮酒和药物使用在参与 HIV 护理中的作用。

The roles of heavy drinking and drug use in engagement in HIV care among hospitalized substance using individuals with poorly controlled HIV infection.

机构信息

Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA.

Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Miami, Florida, 33136 USA.

出版信息

Drug Alcohol Depend. 2019 Aug 1;201:171-177. doi: 10.1016/j.drugalcdep.2019.03.024. Epub 2019 Jun 5.

DOI:10.1016/j.drugalcdep.2019.03.024

PMID:31234013

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6677390/

Abstract

BACKGROUND

Substance use can reduce care engagement for individuals with HIV. However, little is known as to whether heavy drinkers differ from drug users. This study compares heavy drinkers, drug users, and those drinking heavily and using drugs on their HIV care engagement.

METHODS

HIV-infected adult inpatients (n = 801; 67% male; 78% Black) from 11 urban hospitals across the United States participated in a multisite clinical trial to improve patient engagement in HIV care and virologic outcomes. All participants drank heavily and/or used drugs, and had poorly controlled HIV. Participants reported care history at baseline. We compared heavy drinkers, drug users, and those both drinking heavily and using drugs (reference group) on their engagement in care.

RESULTS

Heavy drinkers reported lowest rates of lifetime HIV care, AOR = 0.59 (95% CI = 0.36, 0.97). Groups did not differ in recent care, prescription of HIV medication, medical mistrust, or patient-provider relationship. Drug users evidenced the best medication adherence, AOR = 2.38 (95% CI = 1.33, 4.23). Exploratory analyses indicated that drinkers had lower initial care engagement, but that it increased more rapidly with duration of known HIV infection, with similar rates of recent care. Drinkers had the lowest CD4 counts (B=-0.28, p < 0.0001), but no difference in viral load.

CONCLUSIONS

Heavy drinkers were least likely to have ever been in HIV care. More research is needed to determine why heavy drinkers evidence the lowest initial care engagement and current CD4 counts, and whether drinking intervention early in infection may increase HIV care engagement.

摘要

背景

物质使用会降低 HIV 感染者的护理参与度。然而，目前尚不清楚重度饮酒者和吸毒者是否存在差异。本研究比较了重度饮酒者、吸毒者以及同时大量饮酒和吸毒者的 HIV 护理参与度。

方法

来自美国 11 家城市医院的 801 名 HIV 感染成年住院患者（67%为男性；78%为黑人）参与了一项旨在提高患者 HIV 护理参与度和病毒学结果的多中心临床试验。所有参与者均大量饮酒和/或使用毒品，且 HIV 控制不佳。参与者在基线时报告了护理史。我们比较了重度饮酒者、吸毒者以及同时大量饮酒和吸毒者（参照组）的护理参与度。

结果

重度饮酒者报告的终生 HIV 护理率最低，AOR=0.59（95%CI=0.36，0.97）。各组在最近的护理、HIV 药物处方、医疗不信任或医患关系方面无差异。吸毒者的药物依从性最好，AOR=2.38（95%CI=1.33，4.23）。探索性分析表明，饮酒者的初始护理参与度较低，但随着已知 HIV 感染持续时间的增加，其护理参与度增加得更快，最近的护理率也相似。饮酒者的 CD4 计数最低（B=-0.28，p<0.0001），但病毒载量无差异。