Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
British Columbia Centre on Substance Use, 1045 Howe Street, V6Z 2A9, Vancouver, BC, Canada.
AIDS Behav. 2022 Oct;26(10):3356-3364. doi: 10.1007/s10461-022-03648-y. Epub 2022 Apr 16.
We sought to evaluate the effect of crack cocaine use frequency on HIV disease severity among HIV-positive people who use unregulated drugs (PWUD). We analyzed data from the ACCESS study, an open prospective cohort of HIV-positive PWUD including comprehensive HIV clinical monitoring in a setting with no-cost healthcare. Multivariable generalized linear mixed-effects models were used to estimate the independent effect of time-updated crack cocaine use frequency on HIV disease severity, adjusting for ART exposure and relevant confounders. In multivariable adjusted models, daily or greater frequency of crack cocaine use was significantly associated with higher VACS Index scores (β = 0.8, 95% confidence interval: 0.1, 1.5) as compared to none. Our finding suggests that daily or greater frequency of crack cocaine use exacerbates HIV disease severity independent of ART exposure. The observed effect may reflect an underlying biological mechanism or other factors linked with crack cocaine use; further investigation is warranted.
我们旨在评估可卡因使用频率对感染 HIV 且使用未经管制药物的吸毒者（PWUD）中 HIV 疾病严重程度的影响。我们分析了 ACCESS 研究的数据，该研究是一项针对 HIV 阳性 PWUD 的开放前瞻性队列研究，在免费医疗保健环境中进行了全面的 HIV 临床监测。多变量广义线性混合效应模型用于估计可卡因使用频率的时间更新对 HIV 疾病严重程度的独立影响，同时调整了 ART 暴露和相关混杂因素。在多变量调整模型中，与无可卡因使用相比，每日或更高频率的可卡因使用与更高的 VACS 指数评分显著相关（β=0.8，95%置信区间：0.1，1.5）。我们的发现表明，与 ART 暴露无关，每日或更高频率的可卡因使用会加重 HIV 疾病的严重程度。观察到的影响可能反映了与可卡因使用相关的潜在生物学机制或其他因素；需要进一步的研究。
