Illicit Substance Use Reduction May Improve Psychological Outcomes in PLWH

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Reducing illicit substance use in PLWH may be associated with improvements in depressive symptoms.
Reducing illicit substance use in PLWH may be associated with improvements in depressive symptoms.

For people living with HIV (PLWH), reducing illicit substance use may be associated with improvements in depressive symptoms, according to study results published in the Journal of Acquired Immune Deficiency Syndromes.

The study included participants with HIV from the Centers for AIDS Research Network of Integrated Clinical Sites (CNICS) cohort (n=9905). Participants completed longitudinal assessments of substance abuse using a modified form of the Alcohol, Smoking, and Substance Involvement Screening Test and depressive symptoms (using the Patient Health Questionnaire-9 [PHQ-9]).

The researchers categorized changes in substance use frequency as abstinence, reduced use, and non-decreasing use. They used adjusted linear mixed models with time-updated change in substance use frequency and depressive symptom scores to determine associations between changes in the use of substances and depressive symptoms.

At baseline, 728 PLWH reported using cocaine/crack, 1016 reported using amphetamine-type substances (ATS), 290 reported using illicit opiates, and 3277 reported using marijuana.

The results indicated that changes in ATS use were associated with the greatest improvements in depressive symptoms.

Participants who stopped ATS had a mean decrease of 2.2 points in PHQ-9 score and 61% lower odds of PHQ-9 score ≥10. Participants who decreased ATS use had a mean decrease of 1.7 points in PHQ-9 score and 62% lower odds of PHQ-9 score ≥10.

Participants who stopped marijuana use had a mean decrease of 0.5 points in PHQ-9 scores and 28% lower odds of PHQ-9 score ≥10. Decreasing marijuana use was associated with a mean decrease of 0.4 points in PHQ-9 score and 30% lower odds of PHQ-9 score ≥10.

Participants who stopped cocaine/crack use had a mean decrease of 0.8 points in PHQ-9 score and 24% lower odds of PHQ-9 score ≥10. However, decreasing cocaine/crack use without stopping was not associated with a significant change in PHQ-9 score or the odds of PHQ-9 score ≥10.

Neither stopping nor reducing the use of opiates was associated with a significant reduction in depressive symptoms in PLWH.

“The results of this study suggest that reduction in substance use can result in better psychological outcomes for PLWH dealing with depressive symptoms,” the researchers wrote.

Reference

Delaney JA, Nance RM, Whitney BM, et al. Reduced use of illicit substances, even without abstinence, is associated with improved depressive symptoms among people living with HIV [published online July 19, 2018]. J Acquir Immune Defic Syndr. doi:10.1097/QAI.0000000000001803

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