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

Han-Zhu Qian,Sten H Vermund,Valerie J Mitchell,Timothy R Sterling,Richard D’Aquila,Todd Hulgan,Sally Bebawy,Holly Cassell,Gina Perez,Catherine C Mcgowan

doi:10.1186/1471-2334-14-508

Han-Zhu Qian, Sten H Vermund + Show 8 more

Open Access

https://doi.org/10.1186/1471-2334-14-508

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Abstract

BackgroundThere 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.MethodsIn 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.ResultsAbout 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).ConclusionsUDS 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.

Highlights

There have been inconsistent findings on the association between current drug use and HIV disease progression and virologic suppression
Patients were recruited by a research nurse during clinic visits at Vanderbilt Comprehensive Care Clinic (VCCC), where they read brochures about this drug userelated study voluntarily decided to participate in the study
A total of 226 HIV-infected patients participated in the study; one participant did not provide a urine sample for urine drug screen (UDS) and was excluded from the analysis

Summary

Introduction

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. Computer Assisted Self Interview (CASI) may reduce but not eliminate such bias [9,10,11] Both questionnaire and CASI interviews can assess past and current use of drugs. Studies on the relationship between use of illicit drugs and HIV disease outcomes often use self-reported history of drug use. There is a scarcity of literature on validation of reported drug use and on the assessments of current drug use and its potential association with HIV treatment outcomes among HIV-infected patients [3,14]. We assessed the agreement between CASI and UDS results in this group of HIV-infected participants, and the relationship between virologic suppression and drug use as assessed by UDS

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Results

Conclusion