Journal Club

People with HIV who Inject Drugs Have Poorer Health Outcomes Compared with People with HIV who Use Only Non-Injectable Drugs

Reviewed by Milana Bogorodskaya, MD

In a recent study published in AIDS and Behavior, Wu et al. compared the health outcomes of people with HIV (PWH) who inject drugs with PWH who only use non-injectable drugs. The study analyzed data obtained by the Medical Monitoring Project. Data were collected through in-person or telephone surveys of randomly selected PWH from the National HIV Surveillance System living in 16 states as well as Puerto Rico and Washington, D.C. Persons who reported using only marijuana were excluded. Overall, 15.6% of PWH reported using drugs, and 2.6% reported injecting drugs in the past 12 months.

The most used injected drugs were methamphetamines (81.8%), heroin (26.9%), and cocaine (14.6%). The drugs used most by those who did not inject drugs were marijuana (75.0%), cocaine/crack (45.8%), poppers or amyl nitrate (39.7%), and methamphetamines (28.2%). PWH who injected drugs were more likely to report identifying as non-Hispanic White (58.4% vs. 38.9%, P < .001), have household income at or below the poverty threshold (48.6% vs. 40.2%, P = .017), experience homelessness (30.0% vs. 15.6%, P < .001), experience incarceration (16.5% vs. 7.4%, P < .001), engage in high-risk sex (22.7% vs. 12.4%, P < .001) and have a diagnosis of depression (prevalence ratio [PR], 1.41; 95% confidence interval [CI], 1.18-1.68) or anxiety (PR, 1.49; 95% CI, 1.26-1.76) compared with PWH who only used non-injectable drugs. In addition, PWH who injected drugs were less likely to be retained in care (PR, 0.88; 95% CI, 0.80-0.97), be 100% adherent to antiretroviral therapy (PR, 0.73; 95% CI, 0.60-0.88), and have sustained viral suppression (PR, 0.83; 95% CI, 0.74-0.93) compared with PWH who only used non-injectable drugs. Although PWH who inject drugs were more likely to receive mental health services (54.9% vs. 40.1%, P < .001) and drug/alcohol counseling or treatment (37.6% vs. 15.4%, P < .001) compared with those who did not inject drugs, the overall percentages of all patients receiving mental health and drug/alcohol treatment were low.

There are multiple limitations to this study, including a high risk of social desirability and recall bias. Furthermore, a random sample from 16 states may not reflect the population in non-sampled states. Although data were adjusted for nonresponse and weighted for known population totals, it cannot account for potential confounding factors that may have influenced the results.

(Wu et al. AIDS and Behavior. Published online: Sept. 18, 2021.)