Cachay Edward R, Moges Tesfaye S, Qin Huifang, Bamford Laura, Grelotti David J, Mathews Wm Christopher
Department of Medicine, Division of Infectious Disease and Global Public Health, Owen Clinic, UC San Diego School of Medicine, United States.
HIV Neurobehavioral Research Program, Department of Psychiatry, UC San Diego School of Medicine, United States.
Addict Behav Rep. 2023 Mar 11;17:100486. doi: 10.1016/j.abrep.2023.100486. eCollection 2023 Jun.
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.
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.
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.
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.
感染人类免疫缺陷病毒（HIV）且有药物或酒精使用问题的人，其血浆HIV病毒载量（pVL）往往未得到抑制。药物和酒精使用对HIV病毒抑制的影响程度通过药物治疗依从性介导的情况尚未完全明确。
我们纳入了2014年至2018年间在一家学术性HIV诊所接受抗逆转录病毒治疗并接受护理的HIV感染者，这些人完成了患者报告结局（PRO）问卷且随后进行了pVL测量。测量指标包括酒精使用评估（AUDIT-C）、药物使用评估（NIDA-ASSIST）以及使用四种不同方法测量的自我报告依从性。在双变量分析中发现可预测可检测pVL的物质，分别针对通过依从性产生的中介效应进行建模。我们报告自然直接效应（NDE）和间接效应（NIE）、边际总效应（MTE）以及中介百分比。
在3125名符合资格标准的HIV感染者中，25.8%报告有危险酒精使用，27.1%使用大麻，13.1%使用苯丙胺，1.9%使用吸入剂，5.3%使用可卡因，4.5%使用镇静催眠药，2.9%使用阿片类药物，2.3%使用致幻剂。58%的HIV感染者报告依从性良好，10%的人pVL可检测到。除了镇静剂外，使用其他物质与较差的依从性显著相关。可检测pVL的双变量预测因素为[比值比（95%置信区间）]：使用苯丙胺为2.4（1.8 - 3.2），使用阿片类药物为2.3（1.3 - 4.0）。由不依从介导的边际总效应百分比因物质而异：使用苯丙胺为36%，使用阿片类药物为27%，使用多种物质为39%。
使用苯丙胺、阿片类药物和多种物质可预测可检测的pVL。其高达40%的影响是由自我报告的不依从介导的。使用纵向测量模型进行确认将加强从该横断面分析得出的因果推断。
