Drug abuse in people living with HIV in the era of highly active antiretroviral therapy: A systematic review and meta-analysis.
- Public Health Research
Objective: Little is known about the epidemiology of drug abuse in HIV-infected populations. Therefore, we aimed to estimate the prevalence of drug abuse among people living with HIV. We also sought to examine factors potentially associated with drug abuse in this high-risk population subgroup.
Methods: We searched EMBASE and PubMed databases from 1997 to September 2015 for studies that reported crude prevalence estimates of drug abuse in people living with HIV. Using random-effects meta-analysis, we pooled prevalence estimates of all forms of drug abuse, including alcohol, crack/cocaine, methamphetamine, heroin, over-the-counter, tobacco/nicotine, and prescription drugs. We defined drug abuse strictly in terms of its accompanying self-damaging effects. Random-effects meta-regression analysis was performed on all study-level characteristics to identify factors that may be associated with drug abuse in HIV-infected persons.
Results: Seventy two studies, comprising 153,711 HIV-infected participants, met our inclusion criteria. Majority (87%) of the study population was resident in the United States (US). Overall, the prevalence of drug abuse was 33.6% (95% confidence interval [CI] 28.2 to 39.3, I2=99.7%, 31 studies, 28,238 participants), with prescription drugs identified as the most abused (42.7%, 95% CI 25.7 to 60.6, I2=99.7%, 14 studies, 1775 participants). While HIV infection duration (coefficient 0.03, 95% CI 0.0003 to 0.05, P=0.49, explained variance [R2]=51.3%) and ethnicity (Hispanic/Latino) (coefficient 0.006, 95% CI 0.001 to 0.01, P=0.012, R2=23.2%) may be determinants of drug abuse in people living with HIV, exposure to antiretroviral treatment was a strong deterrent (coefficient -0.004, 95% CI -0.01 to -0.0001, P=0.048, R2=10.1%).
Conclusion: One in three HIV-infected persons may be affected by drug abuse, with HIV infection duration and ethnicity (Hispanic) identified as predictors of this disorder. However, most of the available evidence comes from US studies. More studies originating from low- and middle-income countries are needed to obtain more precise estimates.