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The Impact of Substance Use on Adherence to Antiretroviral Therapy Among HIV-Infected Women in the United States

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Abstract

Research is scant regarding differential effects of specific types of recreational drugs use on antiretroviral therapy adherence among women, particularly to single-tablet regimens (STR). This is increasingly important in the context of marijuana legalization. We examined the effects of self-reported substance use on suboptimal (<95%) adherence in the Women’s Interagency HIV Study, 2003–2014. Among 1799 HIV-infected women, the most prevalent substance used was marijuana. In multivariable Poisson GEE regression, substance use overall was significantly associated with suboptimal adherence (adjusted prevalence ratio, aPR = 1.20, 95% CI 1.10–1.32), adjusting for STR use, socio-demographic, behavioral, and clinical factors. Among STR users, compared to no drug use, substance use overall remained detrimental to ART adherence (aPR = 1.61, 95% CI 1.24–2.09); specifically, both marijuana (aPR = 1.48, 95% CI: 1.11–1.97) and other drug use (aPR = 1.87, 95% CI 1.29–2.70) predicted suboptimal adherence. These findings highlight the need to intervene with drug-using women taking antiretroviral therapy to maintain effective adherence.

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Acknowledgements

Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Mary Young and Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I–WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA). The authors would like to thank Chiung-Yu Huang, PhD and Gayle Springer, MLA for statistical advice and data management support.

Funding

This study was funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E7636, Baltimore, MD, 21205, USA

    Yuehan Zhang & Elizabeth T. Golub

  2. Department of Community Health Sciences, SUNY Downstate Medical Center, New York City, NY, USA

    Tracey E. Wilson

  3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Adebola Adedimeji

  4. Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA

    Daniel Merenstein

  5. Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Joel Milam

  6. Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA

    Jennifer Cohen

  7. Departments of Medicine, John Stroger (Formerly Cook County) Hospital and Rush University, Chicago, IL, USA

    Mardge Cohen

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  1. Yuehan Zhang
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  3. Adebola Adedimeji
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  4. Daniel Merenstein
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  8. Elizabeth T. Golub
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Corresponding author

Correspondence to Elizabeth T. Golub.

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Conflict of interest

Dr. Merenstein has been an expert witness on probiotic cases for General Mills, Nestle, Procter and Gamble and Bayer Health. All the other authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Supplementary Fig. 1

Flowchart of the study visits, WIHS, 2003-2014. Semiannual study visits from 2003 to 2014 in the dashed box were included in the analysis. Calendar year was listed as last two digits (i.e. 1994: 94). Supplementary material 1 (TIFF 37 kb)

Supplementary Fig. 2

Study visit of exposure, covariate, and outcome data included in the analysis. Exposure and covariate data (i.e., from visit X) were paired with outcome data (i.e., from visit X + 1 in the analysis. Supplementary material 2 (TIFF 91 kb)

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Zhang, Y., Wilson, T.E., Adedimeji, A. et al. The Impact of Substance Use on Adherence to Antiretroviral Therapy Among HIV-Infected Women in the United States. AIDS Behav 22, 896–908 (2018). https://doi.org/10.1007/s10461-017-1808-4

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