Association between substance use problems and health outcomes among HIV-positive patients in NYC

Background: Substance use among HIV-positive individuals exacerbates health problems and accelerates HIV disease progression. This study sought to examine the impact of co-occurring alcohol and drug-use (ADU) problems on medical conditions in HIV-positive patients in NYC.

Methods: This retrospective cohort study includes electronic medical records (EMRs) of 5,584 HIV-1-infected patients who attended comprehensive care clinics in NYC in 2012.  EMRs were used to assess the prevalence of medical conditions among HIV-positive patients with medically documented ADU problems. 

Results: Patients who had either an alcohol (11%) or a drug-use (32%) problem were found to be at increased risk for respiratory infections, tuberculosis and bacterial infections, viral hepatitis, renal disease and other alcohol-related complications, cardiovascular disease, blood disorders, cancer diagnosis, and nutritional deficiency compared to those who did not (all p < .001).  In logistic regression analyses adjusted for age, race/ethnicity, CD4 cell count, having an undetectable viral load, the risk odds of being diagnosed with three or more medical conditions among those with both ADU problems (9%) was about 4.3 times (95% CI 3.49 to 5.39; p < .001) of that for those without any ADU problems (65%).  Patients with ADU problems had higher odds as well when compared to those with only alcohol (3%) or only drug-use (23%) problems.

Conclusions: HIV-positive patients with co-occurring alcohol and drug-use problems are at increased risk for medical comorbidities. These findings suggest that comprehensive approaches that integrate ways to address ADU problems are needed for HIV-infected patients.