Uso de drogas ilegales en pacientes con VIH en tratamiento antirretroviral

Abstract

A sequential exploratory mixed design study was carried out with the participation of 33 health centres and NGOs. Three multicentre studies were carried out with different methodological designs. In the first, qualitative study, 21 PLHIV on ART who used drugs were interviewed. This study helped to define the research questions and the design of the questionnaire used for the following studies. This was followed by a quantitative cross-sectional ex post-facto study, in which 1,401 PLHIV on ART were surveyed (objectives 1 and 2). A third study was conducted as an observational historical or retrospective cohort study involving 275 PLHIV on ART (146 were recreational drug users (RDU) and 129 were non-drug users (RDNU) (objective 3). Epidemiological, clinical, social and health resource use variables related to drug use in PLHIV on ART were collected. Analysis of the data obtained comprised a variety of statistical techniques depending on the nature of the studies and their objectives. Results The prevalence of illicit drug use among PLHIV on ART was 49.5%. The most commonly used drugs were cannabis, cocaine, poppers and GHB/GBL. Four patterns of use were found; C1- "heterosexual cluster (HTX) cannabis users", C2- "HTX cluster heroin and cocaine users", C3- "MSM cluster with moderate drug use" and, C4- "MSM cluster with high poly-drug use". Within these four, two clusters had different poly-drug use profiles: MSM (whose profile was associated with recreational drug use) with the highest rate of poly-drug use, and who were associated with a higher risk of sexually transmitted infections (STIs), and another cluster predominantly HTX (whose profile was associated with traditional drug use such as heroin), who showed poorer adherence to ART and suffered poorer health outcomes. The prevalence of DDI was 51.1% among RDU. The mean DDI per participant was 2.1±1.7 (range 1-10). The drugs with the highest DDI were cocaine, cannabis, MDMA and GHB/GBL. The ART families most frequently involved in DDI were protease inhibitors, integrase inhibitor-boosted regimens (elvitegravir/cobicistat) and non-nucleoside reverse transcriptase inhibitors. The patterns of use with the highest risk of DDI were C2>C4>C3>C1. RDU were aware of the risk of DDI and its negative influence on health, showing intentional non-adherence behaviours due to toxicity beliefs. The predictors most associated with recreational drug use were being MSM, having previously experienced STIs and being a smoker. Although there were no significant differences in mean CD4, CD8 and CD4/CD8 between the RDU and RDNU, interaction effects were found between the two groups and the evolution of immunological parameters. Thus, while the CD8 percentage decreased in the RDNU group, it remained stable in the RDU group, and while the CD4/CD8 ratio increased in the RDNU group, it decreased in the RDU group. The RDU had more changes in ART during the follow-up period, had lower adherence score levels, poorer psychological health, more visits to the emergency department, and had more laboratory tests. Conclusions PLHIV have a high prevalence of illicit drug use and DDI. The most frequent pattern of drug use is associated with recreational drugs, although drug use associated with a marginal profile persists in a minority. PLHIV with DDI have interaction toxicity beliefs related to drug use and are associated with intentional non-adherence behaviours. Drug use in PLHIV is negatively related to physical and psychological health parameters.