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Background:  Cross-sectional and longitudinal studies with limited follow-up have suggested that active illicit drug use is associated with non-adherence and sub-optimal response to highly active antiretroviral therapy (HAART), as measured by viral load and CD4 cell counts. The goal of this study was to compare HIV disease progression in active drug users (DU), inactive DU, and non-DU.

Methods:  Since 1998 patients at the Johns Hopkins HIV Clinic have participated in brief surveys, addressing substance abuse and other factors, at 6-month intervals. Surveys were administered by confidential computer-assisted-interview. Participants with ≥2 surveys were included in the analysis. DU were defined as patients reporting heroin or cocaine use in at least one survey, while non-DU denied use in all surveys. Survival analysis techniques were used to compare development of new opportunistic conditions in DU and non-DU. In DU, self-reported heroin or cocaine use in the 6 months preceding surveys was included in models as a time-dependent variable (i.e., active DU vs inactive DU).

Results:  A total of 1148 patients (688 non-DU and 460 DU) contributed 4660 surveys over a median follow-up of 2 years. Of the 1960 surveys conducted in DU, participants reported active DU in 1077 (55%) and inactive DU in 883 (45%). Compared with non-DU, active DU was significantly associated with HIV disease progression (p <0.001), but inactive DU was not (p = 0.43) (see the figure below).

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Conclusions:  This study highlights active DU as a time of HIV disease progression in the HAART era, and suggests that non-DU and inactive DU have a similar risk of disease progression.

Keywords: drug abuse; HIV disease progression; highly active antiretroviral therapy