Resumen
BACKGROUND: This study analyzed the impact of recreational drug use (RDU) on clinical outcomes, emotional well-being, and health-related quality of life (HRQoL) in people living with HIV (PLHIV) in Spain.
METHODS: Two cohorts of PLHIV taking antiretroviral therapy (ART) for at least one year were recruited between April 2017 and May 2018 according to their RDU: frequent RDU (consumption '¥1 drug '¥10 times a year, excluding the use of methadone, morphine, and cannabis as a single drug) vs. no-RDU. We collected the following retrospective last 12-month clinical data from clinical records: ART adherence (pharmacy refill), CD4, CD4/CD8 ratio, viral load, resistance to and adverse effects of ART, previous clinical conditions, and use of health services. ART adherence, HRQoL, and psychological well-being were measured through validated tools (CEAT-VIH, WHOQoL-HIV-BREF, and GHQ-12). These variables and self-reported sexually transmitted infections (STIs) were collected at the inclusion visit through a cross-sectional survey. Differences between groups were analyzed through Chi-square, Student T for independent samples, and mixed analysis of variance (ANOVA) using SPSS v.22.
RESULTS: A total of 275 PLHIV were included; 12 were excluded by protocol deviation. The final sample was composed of 51.3% RDU and 48.7% non-RDU. Most participants were male (93.5%) with an average age of 45.8±10.8 years. RDU patients presented lower scores of ART adherence (p=.017, and p=.006, for multi-interval adherence and self-reported adherence respectively), more visits to the emergency unit (p=.046), and marginally more non-AIDS related events (p=.061) but fewer visits to their specialist physician (p=.059). ANOVA results showed that there were significant interactions both between the group membership and the change between the first determination vs. the last in the percentage of CD8 and the CD4/CD8 ratio (p=.020, and p=.024 respectively) during the follow-up year. While the percentage of CD8 decreased among non-RDU, it remained stable among RDU; and while the CD4/CD8 ratio increased among non-RDU, it decreased among RDU. RDU presented lower scores in HRQoL (p< .0001) and emotional well-being than non-RDU (p< .0001).
CONCLUSIONS: This observational retrospective cohort study shows evidence that recreational drug use could worsen PLHIV health outcomes.