Substance Use Disorder Risk Increased in People With HIV During COVID-19 Pandemic

Between 2018 and 2022, a significant increase in moderate and high substance use disorder (SUD) risk was observed among people with HIV infection, according to study results published in Open Forum Infectious Diseases.

Researchers collected data from 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort between 2018 and 2022 to assess the impact of the COVID-19 pandemic on the prevalence of moderate and greater SUD risk among people with HIV enrolled in US HIV routine care, the changes in use of specific substances over time, and predictors of those who increased their SUD risk during the post-COVID-19 timeframe. Adults who completed at least 1 clinical assessment of patient-reported outcomes during a routine visit between March 2018 and September 2022 were eligible for inclusion. The NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test version 2.0 (NM-ASSIST) was used to evaluate substance use among participants. For each drug reported, a Single Substance Involvement Score (SSIS) was created (low risk, 0-3; moderate risk, 4-27; high risk, >27). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. A mixed-effects logistic regression model was used to examine changes in reported moderate/high SUD risk following the shelter-in-place mandate.

A total of 7126 participants (median age at first assessment, 51 years; Black/African American, 46%; White, 46%) were included in the study, which comprised 21,741 SUD assessments.

The rate of at least moderate SUD risk increased from 24% in 2018 to 43% in 2022.

Moderate or high SUD risk was significantly associated with age (per 10 years, adjusted odds ratio [aOR], 1.79; 95% CI, 0.54-0.64; P <.001) and viral nonsuppression (aOR, 1.79; 95% CI, 1.31-2.45; P <.001), which indicated that younger patients and those who were virally unsuppressed were more likely to report moderate/high SUD risk.

Participants with no or mild depressive symptoms exhibited worsening SUD risk over time (per month, aOR, 1.31%; 95% CI, 1.01-1.69; P =.041), while those with moderate or severe depressive symptoms demonstrated consistently high SUD risk over time in the post-COVID-19 era.

Cisgender vs transgender women exhibited lower odds of moderate or high SUD risk (aOR, 0.26; 95% CI, 0.08-0.81; P =.021). Compared with cisgender women and men, transgender women with moderate or severe depression symptoms transgender women with moderate or severe depression demonstrated the greatest increase in moderate or severe SUD risk over time.

Geographic region was a predictor of the odds of increasing to moderate or high SUD risk such that participants from the Northeast (aOR, 0.96; 95% CI, 0.93-0.99; P =.018) and South (aOR, 0.96; 95% CI, 0.94-0.99; P =.013) vs those from the West were less likely to increase in SUD risk.

Methamphetamine, heroin, and opioids obtained without a prescription exhibited the greatest reported increase in use during COVID-19 (P <.001), while prescription opioids and sedatives showed the greatest reported decline in use.

Study limitations include a reduced generalizability of results to those not engaged in HIV care and potential unmeasured confounders.

“To address the combined epidemics of substance use and HIV following the COVID pandemic, a renewed investment in integrated substance use and HIV treatment is vital,” the researchers wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Infectious Disease Advisor