Abigail Zuger, MD

Active use resulted in more missed appointments and lower rates of virologic suppression.

Among HIV-infected patients, blacks have worse outcomes than whites — a fact that has been documented repeatedly yet never adequately explained. Researchers sought to explore the association by quantitating the effects of problematic alcohol/drug use and treatment for substance use on appointment-keeping and virologic suppression among black patients receiving care at a Birmingham, Alabama, clinic.

Most of the 576 participants were male and were newly enrolled in the clinic. At interview, 50% were uninsured, 64% reported “mental health issues,” 34% reported problematic alcohol or drug use during the preceding year, 19% reported long-term at-risk drug or alcohol use, and 13% were receiving or had recently received substance use treatment. The median CD4 count was 321 cells/mm3.

During the 2 years after the interview, the median proportion of scheduled appointments attended was 82%, and the median proportion of RNA assessments showing virologic suppression was 71%. Active substance use reduced rates of appointment keeping, both for patients in drug treatment and for those not in treatment; it also reduced the likelihood of virologic suppression but only among those not in treatment. These associations all lost statistical significance when adjusted for other variables such as age, mental health status, and longtime drug or alcohol use.

Citation(s):

Howe CJ et al. The role of at-risk alcohol/drug use and treatment in appointment attendance and virologic suppression among HIV+ African Americans. AIDS Res Hum Retroviruses 2014 Mar; 30:233.