Polysubstance Use Patterns Associated With HIV Disease Severity Among Those With Substance Use Disorders: A Latent Class Analysis
Nicolas Bertholet, Michael Winter, Timothy Heeren, Alexander Y. Walley, Richard Saitz
Abstract
Background: Polysubstance use is common among people with HIV infection (PWH) and with substance use disorder (SUD) but its effects are under-studied. We aimed to identify polysubstance use patterns over time and assess their associations with HIV disease severity. Methods: In 233 PWH with current or past SUD, latent class analysis identified polysubstance use patterns based on the Alcohol Use Disorders Identification Test-Consumption and past 30-day use of cannabis, cocaine, opioids, and tranquilizers at baseline. We categorized changes in use patterns and tested associations between those changes and CD4 count and HIV viral suppression at 12 months in linear and logistic regressions. Results: Three patterns were identified at baseline: 18% did not use any substance (NONE-a priori defined); 63% used mostly cannabis and alcohol (CA); 19% all used opioids, and also mostly used cocaine, tranquilizers, cannabis and alcohol (MULTI). At 12 months, 40% moved from a high to a lower substance use class (MULTI to CA, either to NONE) or remained as NONE; 43% were in CA both times; 17% increased (NONE to CA, either to MULTI) or remained as MULTI. Adjusted mean CD4 count (for baseline covariates and baseline CD4 count) was significantly lower among participants increasing or remaining in MULTI (523[448-598]cells/mm3) compared to those who decreased/abstained throughout (607[552-663], p=0.02). No significant difference was observed for HIV viral suppression. Conclusions: We identified distinct polysubstance use patterns among PWH and with SUD: cannabis/alcohol, and opioids with alcohol and other drugs. Changes over time towards fewer substances/no use were associated with lower HIV disease severity based on CD4 count but not based on HIV viral suppression.