Recreational Drug Use in People Living with HIV in Spain: Factors Associated with Drug Use and the Impact on Clinical Outcomes.

We analysed the impact of recreational drug use (RDU) on different outcomes in people living with HIV (PLHIV). A multicentre retrospective cohort study was performed with two cohorts of PLHIV included: people using recreational drugs (PURD) vs. people not using recreational drugs (PNURD). Overall, 275 PLHIV were included. RDU was associated with men having sex with men (OR 4.14, 95% CI [1.14, 5.19]), previous sexually transmitted infections (OR 4.00, 95% CI [1.97, 8.13]), and current smoking (OR 2.74, 95% CI [1.44, 5.19]). While the CD4/CD8 ratio increased amongst PNURD during the follow-up year, it decreased amongst PURD (p = 0.050). PURD presented lower scores of self-reported and multi-interval antiretroviral adherence (p = 0.017, and p = 0.006, respectively), emotional well-being (p < 0.0001), and regular follow-up (p = 0.059), but paid more visits to the emergency unit (p = 0.046). RDU worsens clinical, immunological, and mental health outcomes amongst PLHIV.

RESUMEN: Analizamos el impacto del consumo de drogas recreativas sobre variables relacionadas con la salud en personas con VIH (PVIH). Estudio multicéntrico retrospectivo con dos cohortes de PVIH: consumidores de drogas recreativas (CDR) y no consumidores (NCDR). Se incluyeron 275 PVIH. El consumo de drogas recreativas se asoció al colectivo de hombres que mantienen sexo con hombres (OR 4.14, IC95% [1.14, 5.19]), a infecciones de transmisión sexual previas (OR = 4.00, IC95% [1.97, 8.13]) y a ser fumador (OR = 2.74, IC95% [1.44, 5.19]). El ratio CD4/CD8 aumentó entre los NCDR durante el año de seguimiento y disminuyó en los CDR (p = 0.050). Los CDR presentaron peor adherencia al tratamiento antiretroviral medida con dos métodos indirectos (p = 0.017 y p = 0.006, respectivamente), y bienestar emocional (p < 0.0001). Además, visitaron menos al especialista en enfermedades infecciosas (p = 0.059), y más a urgencias (p = 0.046). El consumo de drogas recreativas empeora los resultados clínicos y de salud mental entre las PVIH.

Prevalence and patterns of illicit drug use in people living with HIV in Spain: A cross-sectional study.

This study assessed the prevalence and patterns of drug use among people living with HIV (PLHIV) in Spain. We conducted an observational cross-sectional study including 1401 PLHIV. Data were collected through 33 sites across Spain using an online computer-assisted self-administered interview. The survey measured use of illicit drugs and other substances, treatment adherence and health-related variables. To analyse patterns of drug use we performed cluster analysis in two stages. The most frequently consumed substances were: alcohol (86.7%), tobacco (55.0%), illicit drugs (49.5%), other substances (27.1%). The most prevalent illicit drugs used were cannabis (73.8%), cocaine powder (53.9%), and poppers (45.4%). Results found four clusters of PLHIV who used drugs. Two of them were composed mainly of heterosexuals (HTX): Cluster 1 (n = 172) presented the lowest polydrug use and they were mainly users of cannabis, and Cluster 2 (n = 84) grouped mostly men who used mainly heroin and cocaine; which had the highest percentage of people who inject drugs and presented the lowest level of treatment adherence (79.8±14.2; p < .0001). The other two clusters were composed mainly of men who have sex with men (MSM), who were mostly users of recreational drugs. Cluster 3 (n = 285) reported moderate consumption, both regarding frequency and diversity of drugs used, while Cluster 4 (n = 153) was characterized by the highest drug polyconsumption (7.4±2.2; p < .0001), and 4 grouped MSM who injected recreational drugs, and who reported the highest frequency of use of drugs in a sexual context (2.6±0.8; p < .0001) and rates of sexually transmitted infections (1.8±1.1; p < .01). This is the largest multi-centre cross-sectional study assessing the current prevalence and patterns of drug use among PLHIV in Spain. The highest prevalence of drug use was found among MSM, although HTX who used heroin and cocaine (Cluster 2) had the most problems with adherence to HIV treatment and the worst health status.