Although the use of needles to inject illegal drugs is a known risk factor in the transmission of HIV (more than 180,000 injectable drug users with HIV have died since the HIV epidemic began), less attention has been paid to general patterns of drug use and how it may lead to HIV infection or exacerbate its symptoms. A team of researchers at Columbia University in New York set out to find out if there’s a connection between drug use and HIV.
The team examined files from the National Survey on Drug Use and Human Health (administered by the US Department of Health and Human Services) that encompassed data from 2005 to 2014. These files contained more than 377,000 surveys about respondants’ use of cigarettes, alcohol, marijuana, cocaine, heroin, hallucinogenics, inhalants, and nonmedical use of psychotherapeutics, including whether they ever used them and, if so, how recently. They were also asked if a medical professional had ever diagnosed them with HIV.
Of the total respondents, 548 said they had been diagnosed with HIV. Three-quarters indicated that they had used marijuana at some point in the past versus 44.5% of the uninfected respondents. Furthermore, more than half (57.6%) had used cocaine versus 15.9% of uninfected respondents, almost half (49.2%) had used hallucinogenic drugs versus 15.7% of uninfected respondents, 42.7% had used inhalants versus 8.6% of uninfected respondents, and 47.4% had used psychotherapeutic drugs in a nonmedical capacity versus 21.5% of uninfected respondents. Overall, 46.1% of those with HIV had used illegal drugs versus 14.7% of uninfected respondents, with more than a third (36%) indicating that they had used illegal drugs in the past month versus 8.6% of uninfected participants. This group also had higher rates of cigarette and alcohol usage. The HIV-infected group was largely male (80%), and more of them were between the ages of 35 and 49 than in the uninfected group. In addition, they were more likely to be black, Hispanic, poor, and unmarried than uninfected respondents.
“Our results from a nationally representative dataset indicate higher rates of self-reported drug use in HIV-infected adults compared to HIV-uninfected adults,” said Stephanie Shiau, MPH, a PhD candidate in epidemiology at Columbia University and an author of the study. “These findings are important for HIV prevention, substance-use prevention and treatment, [and] HIV care and treatment considerations.”
According to the study’s authors, the higher rates of drug use, both recent and lifetime, in HIV-positive individuals is concerning. Not only does drug impairment make someone more likely to engage in risky sexual behavior, such as having intercourse without a condom, but drugs themselves can affect the progression of HIV, make someone less likely to follow a treatment protocol, and hinder HIV therapies from working. For example, people using methamphetamines have been shown to suffer from immune system exhaustion. Moreover, other drugs can cause a decline in mental health, making someone less likely to seek out and stick to treatment.
Recognizing that certain racial and ethnic subgroups of the population are likely to be disproportionately impacted by HIV infection, the authors assert that interventions such as HIV and substance abuse prevention programs must be tailored to these particular people. “Coordinated care programs that integrate substance use care and medical care will be especially important to engage affected populations,” said Dr. Shiau.
By Laurie Saloman