Current drug use and lack of HIV virologic suppression: point-of-care urine drug screen versus self-report

BMC Infectious Diseases

Todd Hulgan⁵  Richard D’Aquila¹  Sten H Vermund²  Timothy R Sterling⁵  Catherine C McGowan⁵  Gina Perez³  Holly Cassell²  Sally Bebawy⁵  Valerie J Mitchell³  Han-Zhu Qian⁴ 

[1] Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA;Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA;Division of Infectious Diseases, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA;Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA;Vanderbilt Comprehensive Care Clinic, Nashville, Tennessee, USA

关键词: Virologic suppression;    Antiretroviral therapy;    Urine drug screen;    Computer-assisted self-interview;    HIV;    Drug use;   

Others  :  1125536
DOI  :  10.1186/1471-2334-14-508

 received in 2013-10-18, accepted in 2014-09-15,  发布年份 2014

【 摘 要 】

Background

There have been inconsistent findings on the association between current drug use and HIV disease progression and virologic suppression. Drug use was often measured using self-report of historical use. Objective measurement of current drug use is preferred.

Methods

In this cross-sectional study, we assessed drug use through Computer-Assisted Self Interviews (CASI) and point-of-care urine drug screen (UDS) among 225 HIV-infected patients, and evaluated the association between current drug use and virologic suppression.

Results

About half (54%) of participants had a positive UDS, with a lower self-reported rate by CASI (42%) (Kappa score = 0.59). By UDS, 36.0% were positive for marijuana, 25.8% for cocaine, 7.6% for opiates, and 2.2% for methamphetamine or amphetamine. Factors associated with virologic suppression (plasma HIV RNA <50 copies/mL) were Caucasian race (P = 0.03), higher CD4 count (P < 0.01), current use of antiretroviral therapy (ART) (P < 0.01), and a negative UDS (P < 0.01). Among 178 current ART users, a positive UDS remained significantly associated with lower likelihood of virologic suppression (P = 0.04).

Conclusions

UDS had good agreement with CASI in detecting frequently used drugs such as marijuana and cocaine. UDS at routine clinic visits may provide “real-time” prognostic information to optimize management.

【 授权许可】

   
2014 Qian et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Qian HZ, Stinnette SE, Rebeiro PF, Kipp A, Shepherd BE, Samenow CP, Jenkins CA, McGowan CC, Hulgan T, Sterling TR: The relationship of history injecting and non-injecting drug use with HIV disease progression. J Subst Abuse Treat 2011, 41(1):14-20.
• [2]Perez-Hoyos S, del Amo J, Muga R, del Romero J, de Garcia OP, Guerrero R, Hernandez-Aguado I: Effectiveness of highly active antiretroviral therapy in Spanish cohorts of HIV seroconverters: differences by transmission category. Aids 2003, 17(3):353-359.
• [3]Rasbach DA, Desruisseau AJ, Kipp AM, Stinnette S, Kheshti A, Shepherd BE, Sterling TR, Hulgan T, McGowan CC, Qian HZ: Active cocaine use is associated with lack of HIV-1 virologic suppression independent of nonadherence to antiretroviral therapy: use of a rapid screening tool during routine clinic visits. AIDS Care 2013, 25(1):109-117.
• [4]Kipp AM, Desruisseau AJ, Qian HZ: Non-injection drug use and HIV disease progression in the era of combination antiretroviral therapy. J Subst Abus Treat 2011, 40(4):386-396.
• [5]Chaisson RE, Keruly JC, Moore RD: Race, sex, drug use, and progression of human immunodeficiency virus disease. N Engl J Med 1995, 333(12):751-756.
• [6]Kapadia F, Cook JA, Cohen MH, Sohler N, Kovacs A, Greenblatt RM, Choudhary I, Vlahov D: The relationship between non-injection drug use behaviors on progression to AIDS and death in a cohort of HIV seropositive women in the era of highly active antiretroviral therapy use. Addiction 2005, 100(7):990-1002.
• [7]Johnson T, Fendrich M: Modeling sources of self-report bias in a survey of drug use epidemiology. Ann Epidemiol 2005, 15(5):381-389.
• [8]Sloan JJ, Bodapati MR, Tucker TA: Respondent misreporting of drug use in selfreports: social desirability and other correlates. J Drug Issues 2004, 34:269.
• [9]Gribble JN, Miller HG, Rogers SM, Turner CF: Interview mode and measurement of sexual behaviors: methodological issues. J Sex Res 1999, 36(1):16-24.
• [10]Hutton HE, Lyketsos CG, Zenilman JM, Thompson RE, Erbelding EJ: Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. Am J Psychiatry 2004, 161(5):912-914.
• [11]Islam MM, Topp L, Conigrave KM, van Beek I, Maher L, White A, Rodgers C, Day CA: The reliability of sensitive information provided by injecting drug users in a clinical setting: clinician-administered versus audio computer-assisted self-interviewing (ACASI). AIDS Care 2012, 24(12):1496-1503.
• [12]Holler JM, Bosy TZ, Klette KL, Wiegand R, Jemionek J, Jacobs A: Comparison of the Microgenics CEDIA heroin metabolite (6-AM) and the Roche Abuscreen ONLINE opiate immunoassays for the detection of heroin use in forensic urine samples. J Anal Toxicol 2004, 28(6):489-493.
• [13]Smith ML, Shimomura ET, Summers J, Paul BD, Nichols D, Shippee R, Jenkins AJ, Darwin WD, Cone EJ: Detection times and analytical performance of commercial urine opiate immunoassays following heroin administration. J Anal Toxicol 2000, 24(7):522-529.
• [14]Basurto FZ, Montes JMG, Cubos PF, Santed FS: Validity of the self-report on drug use by university students: Correspondence between self-reported use and use detected in urine. Psicothema 2009, 21:213-219.
• [15]Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA: The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 1998, 158(16):1789-1795.
• [16]Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, Maynard C, Burman ML, Kivlahan DR: Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med 2003, 163(7):821-829.
• [17]Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, Wu AW, Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG): Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care 2000, 12(3):255-266.
• [18]Peace MR, Tarnai LD, Poklis A: Performance evaluation of four on-site drug-testing devices for detection of drugs of abuse in urine. J Anal Toxicol 2000, 24(7):589-594.
• [19]Saitz R: Clinical practice. Unhealthy alcohol use. N Engl J Med 2005, 352(6):596-607.
• [20]Kroenke K, Spitzer RL, Williams JB: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001, 16(9):606-613.
• [21]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33(1):159-174.
• [22]Chander G, Himelhoch S, Fleishman JA, Hellinger J, Gaist P, Moore RD, Gebo KA: HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use. AIDS Care 2009, 21(5):655-663.
• [23]Colon HM, Perez CM, Melendez M, Marrero E, Ortiz AP, Suarez E: The validity of drug use responses in a household survey in Puerto Rico: comparison of survey responses with urinalysis. Addict Behav 2010, 35(7):667-672.
• [24]Fendrich M, Mackesy-Amiti ME, Johnson TP: Validity of self-reported substance use in men who have sex with men: comparisons with a general population sample. Ann Epidemiol 2008, 18(10):752-759.
• [25]van Griensven F, Naorat S, Kilmarx PH, Jeeyapant S, Manopaiboon C, Chaikummao S, Jenkins RA, Uthaivoravit W, Wasinrapee P, Mock PA, Tappero JW: Palmtop-assisted self-interviewing for the collection of sensitive behavioral data: randomized trial with drug use urine testing. Am J Epidemiol 2006, 163(3):271-278.
• [26]Kerr T, Marshall BD, Milloy MJ, Zhang R, Guillemi S, Montaner JS, Wood E: Patterns of heroin and cocaine injection and plasma HIV-1 RNA suppression among a long-term cohort of injection drug users. Drug Alcohol Depend 2012, 124(1–2):108-112.
• [27]Hahn JA, Samet JH: Alcohol and HIV disease progression: weighing the evidence. Curr HIV/AIDS Rep 2010, 7(4):226-233.
• [28]Drainoni ML, Farrell C, Sorensen-Alawad A, Palmisano JN, Chaisson C, Walley AY: Patient perspectives of an integrated program of medical care and substance use treatment. AIDS Patient Care STDS 2014, 28(2):71-81.
• [29]Westergaard RP, Ambrose BK, Mehta SH, Kirk GD: Provider and clinic-level correlates of deferring antiretroviral therapy for people who inject drugs: a survey of North American HIV providers. J Int AIDS Soc 2012, 15(1):10. BioMed Central Full Text
• [30]SAMHSA: Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). (Treatment Improvement Protocol (TIP) Series, No. 47) Appendix B. Urine Collection and Testing Procedures and Alternative Methods for Monitoring Drug Use. 2006. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64092/ webcite
• [31]Silverberg MJ, Ray GT, Saunders K, Rutter CM, Campbell CI, Merrill JO, Sullivan MD, Banta-Green CJ, Von Korff M, Weisner C: Prescription long-term opioid use in HIV-infected patients. Clin J Pain 2012, 28(1):39-46.
• [32]McMahon JH, Manoharan A, Wanke CA, Mammen S, Jose H, Malini T, Kadavanu T, Jordan MR, Elliott JH, Lewin SR, Mathai D: Pharmacy and self-report adherence measures to predict virological outcomes for patients on free antiretroviral therapy in Tamil Nadu, India. AIDS Behav 2013, 17(6):2253-2259.
• [33]Liu H, Golin CE, Miller LG, Hays RD, Beck CK, Sanandaji S, Christian J, Maldonado T, Duran D, Kaplan AH, Wenger NS: A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med 2001, 134(10):968-977.