Article

Patterns of drug use and abuse among aging adults with and without HIV: A latent class analysis of a US Veteran cohort

Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.
Drug and alcohol dependence (Impact Factor: 3.28). 08/2010; 110(3):208-20. DOI: 10.1016/j.drugalcdep.2010.02.020
Source: PubMed

ABSTRACT This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and socio-demographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22-86), primarily male (95%) and African-American (64%). Five distinct patterns emerged: non-users, past primarily marijuana users, past multidrug users, current high consequence multidrug users, and current low consequence primarily marijuana users. HIV status strongly influenced class membership. Non-users were most prevalent among HIV uninfected (36.4%) and current high consequence multidrug users (25.5%) were most prevalent among HIV-infected. While problems of obesity marked those not currently using drugs, current users experienced higher prevalences of medical or mental health disorders. Multimorbidity was highest among past and current multidrug users. HIV-infected participants were more likely than HIV-uninfected participants to be current low consequence primarily marijuana users. In this sample, active drug use and abuse were common. HIV-infected and uninfected Veterans differed on extent and patterns of drug use and on important characteristics within identified classes. Findings have the potential to inform screening and intervention efforts in aging drug users with and without HIV.

Full-text

Available from: Kendall J Bryant, Apr 27, 2015
0 Followers
 · 
92 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Among persons who inject drugs (PWID) polydrug use has important health consequences. Specific drug combinations and drug use practices are highly dependent upon local drug markets. Relatively little is known about polydrug use in San Diego where black tar heroin and methamphetamine dominate. Methods: This study analyzed baseline data from an ongoing cohort study of PWID. Latent class analysis (LCA) was used to identify patterns of weekly polydrug use (heroin, methamphetamine, prescription drugs, alcohol, and marijuana) via multiple routes of administration (injection, smoking, and swallowing). Logistic regression was used to identify demographic characteristics, HIV risk behaviors, and health outcomes associated with class membership. Results: The sample included 511 mostly white (51.5%) males (73.8%), with mean age of 43.5 years. Two distinct classes of drug users predominated: methamphetamine by multiple routes (51%) and heroin by injection (49%). In multivariable logistic regression analysis, class membership was associated with age, race, and housing status. PWID who were HIV-seropositive and reported prior sexually transmitted infections had increased odds of belonging to the methamphetamine class. Those who were HCV-positive and reported previous opioid overdose had an increased odds of being in the primarily heroin injection class (all p-values <0.05). Conclusions: LCA provides a parsimonious depiction of the interplay between drug use class, engagement in risky behavior, and adverse health outcomes. This approach allowed us to identify sub-populations of illicit drug use and related risk behaviors. This information has implications for tailored interventions to prevent infectious disease and overdose among PWID.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite effective antiretroviral therapy (ART), HIV-infected individuals have residual chronic immune activation that contributes to the pathogenesis of HIV infection. This immune system dysregulation is a pathogenic state manifested by very low naïve T-cell numbers and increased terminally differentiated effector cells that generate excessive proinflammatory cytokines with limited functionality. Immune exhaustion leaves an individual at risk for accelerated aging-related diseases, including renal dysfunction, atherosclerosis, diabetes mellitus, and osteoporosis. We highlight research that clarifies the role of HIV, ART, and other factors that contribute to the development of these diseases among HIV-infected persons.
    Infectious Disease Clinics of North America 09/2014; 28(3):457-476. DOI:10.1016/j.idc.2014.05.003 · 2.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although high rates of alcohol consumption and related problems have been observed among HIV-infected men who have sex with men (MSM), little is known about the long-term patterns of and factors associated with hazardous alcohol use in this population. We sought to identify alcohol use trajectories and correlates of hazardous alcohol use among HIV-infected MSM. Sexually active, HIV-infected MSM participating in the Veterans Aging Cohort Study were eligible for inclusion. Participants were recruited from VA infectious disease clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Data from annual self-reported assessments and group-based trajectory models were used to identify distinct alcohol use trajectories over an eight-year study period (2002-2010). We then used generalized estimate equations (GEE) to examine longitudinal correlates of hazardous alcohol use (defined as an AUDIT-C score ≥4). Among 1065 participants, the mean age was 45.5 (SD=9.2) and 606 (58.2%) were African American. Baseline hazardous alcohol use was reported by 309 (29.3%). Group-based trajectory modeling revealed a distinct group (12.5% of the sample) with consistently hazardous alcohol use, characterized by a mean AUDIT-C score of >5 at every time point. In a GEE-based multivariable model, hazardous alcohol use was associated with earning <$6000 annually, having an alcohol-related diagnosis, using cannabis, and using cocaine. More than 1 in 10 HIV-infected MSM US veterans reported consistent, long-term hazardous alcohol use. Financial insecurity and concurrent substance use were predictors of consistently hazardous alcohol use, and may be modifiable targets for intervention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 01/2015; 148. DOI:10.1016/j.drugalcdep.2014.12.023 · 3.28 Impact Factor