Abstinence from the use of illicit drugs including marijuana, cocaine/crack, methamphetamines, and opioids is associated with viral suppression, according to a study published in Clinical Infectious Diseases. In the case of methamphetamine and opioids, a reduction in usage was linked with viral suppression.

This study included 12,492 people living with HIV, all of whom were ≥18 years of age (mean age, 44 years; 47% white) and who participated in longitudinal substance use assessments. The mean follow-up time was 3.9±2.6 years. All participants used one of the drugs of interest at baseline and completed 2 measures of viral load. Longitudinal and survival models were used to investigate the effects of abstinence and reduced drug use on viral suppression. Linear mixed models were used to repeat analyses investigating correlations between viral load and variances in drug use frequency.

Viral suppression was noted in all participants who practiced abstinence. Researchers determined an odds ratio (OR) of 1.42 (95% CI, 1.24-1.63) in the case of marijuana use, and 2.18 (95% CI, 1.56-3.04) for use of illicit opioids. Reduction of drug use without abstinence showed efficacy in increasing viral suppression among users of methamphetamine (OR 1.65; 95% CI, 1.25-2.16) and illicit opioids (OR 2.72; 95% CI, 1.47-5.04).

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Viral load was lower in participants of all 4 drug groups who practiced abstinence, with a log10 viral load difference of -0.218 among those abstaining from opioids (P <.001; viral load, 0.61 relative to those continuing use without reducing frequency), -0.239 among those abstaining from methamphetamine (P <.001; relative viral load, 0.58), -0.160 among those abstaining from cocaine/crack (P <.001; relative viral load, 0.69), and 0.105 among those abstaining from marijuana (P <.001; relative viral load, 0.79).

Limitations to the study included an observational study design, a focus on frequency of use, a lack of certainty in terms of causality, and a lack of assessment as to why people with HIV may reduce frequency of drug use.

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The study researchers concluded that “we demonstrated associations over time with abstinence from illicit opioids, [methamphetamines], cocaine/crack, and marijuana and viral suppression or lower [viral load]. In addition, the impact on [viral load] of reducing use of illicit opioids and [methamphetamine] without abstinence highlights the potential benefits of harm-reduction substance use interventions that are able to successfully reduce use even when abstinence is not achieved.”

Several authors report financial associations with pharmaceutical companies. For a full list of author disclosures, see the reference.


Nance RM, Trejo MEP, Whitney BM, et al. Impact of abstinence and of reducing illicit drug use without abstinence on HIV viral load [published online April 17, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciz299