Associations between hard drug use and HIV disease progression among HIV-positive men who have sex with men (MSM) accessing ryan white services in New York City

BACKGROUND: Hard drug use poses multiple challenges to maintaining physical health among HIV-infected individuals, particularly with regard to disease progression. Few studies, however, have examined the association between hard drug use and HIV disease progression specifically among HIV-positive men who have sex with men (MSM). Understanding this relationship among HIV-positive MSM is particularly critical because MSM are more likely than other men to use hard drugs. There is also evidence that HIV-positive MSM are more likely than HIV-negative MSM to use hard drugs. METHODS: Associations between recent hard drug use (crystal methamphetamine, crack/cocaine, heroin, off-label prescription medications) and HIV disease progression (viral load ≥400 copies/mL, CD4 count <350 cells/mm³) were analyzed for 3729 HIV-positive MSM enrolled in Ryan White Part A programs between November 2010 and November 2012. RESULTS: The sample was predominantly black/Hispanic (76%), 30-49 years-old (55%), US-born (72%), high school-educated or more (70%), stably housed (81%), and diagnosed with HIV after 2000 (63%). Hard drug use (reported by 16%) was independently associated with unsuppressed viral load (37% vs. 20%, AOR=1.97, CI=1.59-2.44) and lower CD4 (57% vs. 44%, AOR=1.55, CI=1.28-1.87) in multivariate analyses controlling for sociodemographic characteristics. CONCLUSIONS: To date, little research has examined how drug use among HIV-positive MSM influences clinical outcomes. This study showed a significant independent association between hard drug use and disease progression among MSM in an HIV service population. Future studies should examine biological and psychosocial mediators of this relationship to inform intervention development for MSM hard drug users in HIV care settings.