Skating on thin ice: stimulant use and sub-optimal adherence to HIV pre-exposure prophylaxis.
Skating on thin ice: stimulant use and sub-optimal adherence to HIV pre-exposure prophylaxis.
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DOI：
10.1002/jia2.25103
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发表时间：
2018-03
影响因子：
6
通讯作者：
Carrico AW
中科院分区：
文献类型：
--
作者：
Hojilla JC;Vlahov D;Glidden DV;Amico KR;Mehrotra M;Hance R;Grant RM;Carrico AW
使用兴奋剂和大量饮酒很普遍，与男男性行为者（MSM）和变性妇女中艾滋病毒血清转化的风险增加有关。此外，每一项都可能对艾滋病毒感染者坚持抗逆转录病毒治疗造成困难。很少有研究检查了兴奋剂和重度酒精使用与MSM和变性妇女坚持每日口服暴露前预防（PrEP）的关系。为了解决文献中的这一差距，我们评估了兴奋剂使用和酗酒与次优PrEP依从性前瞻性相关的假设。我们分析了iPrEx开放标签扩展研究中嵌套病例队列受试者的数据。评估了过去30天内的兴奋剂使用（即粉末可卡因、快克可卡因、可卡因糊、甲基苯丙胺、卡西酮）和酗酒（即一天内饮酒≥5次）。使用免疫测定法检测基线尿液中的兴奋剂，以减少错误分类。次优依从性定义为替诺福韦药物浓度在干血斑中小于700 fmol/孔，表明每周少于4次给药。我们在4周随访访视时测试了兴奋剂使用和酗酒与次优依从性的前瞻性相关性。分析了330名参与者的数据。大多数参与者是MSM（89%），基线时的中位年龄为29岁（四分位数范围24至39）。在过去30天内，大约16%（52/330）的人使用兴奋剂，22%（72/330）的人报告酗酒。在校正分析中，与非使用者相比，兴奋剂使用者的次优PrEP依从性几率高5倍（校正比值比[aOR] 5.04; [95% CI 1.35至18.78]）。在调整兴奋剂使用和基线混杂因素后，自我报告的酗酒与次优依从性无显著相关性（aOR 1.16 [0.49至2.73]）。抑郁症状、变性和性伴侣数量也与次优PrEP依从性无显著相关性（p > 0.05）。兴奋剂使用是PrEP开始后一个月内次优PrEP依从性的风险因素。减少兴奋剂使用的综合预防方法可能会优化PrEP依从性。还应考虑制定坚持计划，专门解决持续使用兴奋剂背景下的PrEP给药问题。
Stimulant and heavy alcohol use are prevalent and associated with elevated risk for HIV seroconversion among men who have sex with men (MSM) and transgender women. In addition, each can pose difficulties for antiretroviral adherence among people living with HIV. Scant research has examined the associations of stimulant and heavy alcohol use with adherence to daily oral pre‐exposure prophylaxis (PrEP) among MSM and transgender women. To address this gap in the literature, we evaluated the hypothesis that stimulant use and binge drinking are prospectively associated with sub‐optimal PrEP adherence. We analysed data from participants in a nested case‐cohort in the iPrEx open label extension. Stimulant use (i.e. powder cocaine, crack‐cocaine, cocaine paste, methamphetamine, cathinone) and binge drinking (i.e. ≥5 drinks in a single day) in the last 30 days were assessed. Baseline urine was tested for stimulants using immunoassays to reduce misclassification. Sub‐optimal adherence was defined as tenofovir drug concentrations in dried blood spots less than 700 fmol per punch, indicative of less than four doses per week. We tested the prospective association of stimulant use and binge drinking with sub‐optimal adherence at the 4‐week follow‐up visit. Data from 330 participants were analysed. The majority of the participants were MSM (89%) with a median age at baseline of 29 years (interquartile range 24 to 39). Approximately 16% (52/330) used stimulants and 22% (72/330) reported binge drinking in the last 30 days. Stimulant users had fivefold greater odds of sub‐optimal PrEP adherence compared to non‐users in adjusted analysis (adjusted odds ratio [aOR] 5.04; [95% CI 1.35 to 18.78]). Self‐reported binge drinking was not significantly associated with sub‐optimal adherence after adjusting for stimulant use and baseline confounders (aOR 1.16 [0.49 to 2.73]). Depressive symptoms, being transgender, and number of sex partners were also not significantly associated with sub‐optimal PrEP adherence (p > 0.05). Stimulant use is a risk factor for sub‐optimal PrEP adherence in the month following PrEP initiation. Comprehensive prevention approaches that reduce stimulant use may optimize PrEP adherence. Creating adherence plans that specifically address PrEP dosing in the context of ongoing stimulant use should also be considered.
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DOI：
10.1080/09540120802385579
发表时间：
2009-01-01
影响因子：
1.7
作者：
Marquez, Carina;Mitchell, Samuel J.;Klausner, Jeffrey D.
通讯作者：
Klausner, Jeffrey D.
影响因子：
15.8
作者：
Liu A;Cohen S;Follansbee S;Cohan D;Weber S;Sachdev D;Buchbinder S
通讯作者：
Buchbinder S
DOI：
10.1016/s2352-3018(15)00206-4
发表时间：
2015-12
期刊：
The lancet. HIV
影响因子：
--
作者：
Deutsch MB;Glidden DV;Sevelius J;Keatley J;McMahan V;Guanira J;Kallas EG;Chariyalertsak S;Grant RM;iPrEx investigators
通讯作者：
iPrEx investigators
影响因子：
168.9
作者：
Choopanya, Kachit;Martin, Michael;Vanichseni, Suphak
通讯作者：
Vanichseni, Suphak
影响因子：
11.8
作者：
Blashill, Aaron J.;Ehlinger, Peter P.;Safren, Steven A.
通讯作者：
Safren, Steven A.