Human immunodeficiency virus type 1 (HIV) continues to disproportionately affect men who have sex with men (MSM). Recent concern has focused on the use of 'club' drugs among MSM as a risk factor for HIV acquisition and transmission. To determine the extent to which the current literature demonstrates a causal association between use of individual 'club' drugs and risk for HIV among MSM, Hill's criteria for causation was applied to existing studies. A theoretical framework that demonstrates potential pathways through which these drugs could be associated with HIV acquisition is proposed, and definitions of what constitutes a 'club' drug discussed. Building upon this review, and addressing the Centers for Disease Control and Prevention's call for research addressing prevention among HIV positive individuals, substance use as a risk factor for unprotected anal intercourse (UAI) was investigated among MSM with recent HIV infection. All MSM were interviewed using a computer assisted survey instrument (CASI) on average 5 weeks after HIV diagnosis and 13 weeks after estimated date of infection. Associations between substance use and UAI in within-subjects analyses were modeled using conditional logistic regression (CLR). Associations between substance use and UAI in the entire sample were examined using generalized estimating equations (GEE). GEE models that included interactions between timing of sexual activity (before versus after diagnosis) and substance use were used to examine change in associations between UAI and substance use before and after HIV diagnosis. Among participants, 16% reported no UAI with any of their last three partners; 60% (n=116) reported UAI with some, but not all, of their last three partners; and 24% reported UAI with all of their last three partners. In multivariate CLR (n=116) and GEE (n=194) models, UAI was associated with use of methamphetamine (OR: 4.9 and 2.7 respectively), marijuana (OR: 4.0 and 1.9 respectively) and erectile dysfunction medications when used with a main partner (OR: 26.0 and 17.1 respectively). In GEE models (n=207) that examined interactions between UAI and substance use before and after HIV diagnosis, UAI was associated with methamphetamine use alone (OR=4.80, 95% CI: 1.4, 16.1) and a combination of methamphetamine and other substances (OR=4.11, 95% CI: 1.9, 8.8) before diagnosis. After HIV diagnosis, UAI was associated with use of substances other than methamphetamine (OR=1.96, 95% CI: 1.3, 5.3) and a combination of methamphetamine and other substances (OR=5.08, 95% CI: 2.3, 11.2), but not methamphetamine alone. These analyses indicate that a direct association may exist between use of methamphetamine and may be differentially associated with UAI based on knowledge of HIV status. These findings have implications for both prevention of high risk sexual behavior and substance use among recently HIV infected MSM

OBJECTIVES: People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand-supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. DESIGN AND METHODS: Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. RESULTS: Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. CONCLUSIONS: Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.

OBJECTIVE: To examine associations between frailty and drug, alcohol, and tobacco use among a large diverse cohort of people with HIV (PWH) in clinical care in the current era. METHODS: PWH at 7 sites across the United States completed clinical assessments of patient-reported measures and outcomes between 2016 and 2019 as part of routine care including drug and alcohol use, smoking, and other domains. Frailty was assessed using 4 of the 5 components of the Fried frailty phenotype and PWH were categorized as not frail, pre-frail, or frail. Associations of substance use with frailty were assessed with multivariate Poisson regression. RESULTS: Among 9336 PWH, 43% were not frail, 44% were prefrail, and 13% were frail. Frailty was more prevalent among women, older PWH, and those reporting current use of drugs or cigarettes. Current methamphetamine use (1.26: 95% CI 1.07-1.48), current (1.65: 95% CI 1.39-1.97) and former (1.21:95% CI 1.06-1.36) illicit opioid use, and former cocaine/crack use (1.17: 95% CI 1.01-1.35) were associated with greater risk of being frail in adjusted analyses. Current smoking was associated with a 61% higher risk of being frail vs. not frail (1.61: 95% CI 1.41-1.85) in adjusted analyses. CONCLUSIONS: We found a high prevalence of prefrailty and frailty among a nationally distributed cohort of PWH in care. This study identified distinct risk factors that may be associated with frailty among PWH, many of which, such as cigarette smoking and drug use, are potentially modifiable.

Background

People with HIV (PWH) are at increased risk of cardiovascular comorbidities and substance use is a potential predisposing factor. We evaluated associations of tobacco smoking and alcohol use with venous thromboembolism (VTE) in PWH.

Methods

We assessed incident, centrally adjudicated VTE among 12 957 PWH within the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort between January 2009 and December 2018. Using separate Cox proportional hazards models, we evaluated associations of time-updated alcohol and cigarette use with VTE, adjusting for demographic and clinical characteristics. Smoking was evaluated as pack-years and never, former, or current use with current cigarettes per day. Alcohol use was parameterized using categorical and continuous alcohol use score, frequency of use, and binge frequency.

Results

During a median of 3.6 years of follow-up, 213 PWH developed a VTE. One-third of PWH reported binge drinking and 40% reported currently smoking. In adjusted analyses, risk of VTE was increased among both current (HR: 1.44, 95% CI: 1.02-2.03) and former (HR: 1.44, 95% CI: 0.99-2.07) smokers compared to PWH who never smoked. Additionally, total pack-years among ever-smokers (HR: 1.10 per 5 pack-years; 95% CI: 1.03-1.18) was associated with incident VTE in a dose-dependent manner. Frequency of binge drinking was associated with incident VTE (HR: 1.30 per 7 days/month, 95% CI: 1.11-1.52); however, alcohol use frequency was not. Severity of alcohol use was not significantly associated with VTE.

Conclusions

Current smoking and pack-year smoking history were dose-dependently associated with incident VTE among PWH in CNICS. Binge drinking was also associated with VTE. Interventions for smoking and binge drinking may decrease VTE risk among PWH.