Associations between substance use by type and HIV viral suppression across multiple cohorts in the US

Substance use among people with HIV (PWH) represents an important obstacle to further reductions in HIV transmission. Using data from a diverse collection of five studies including people with HIV in care and those in community cohorts, we report results for analyses of the association between substance use and HIV viral non-suppression. We analyzed data from participants from the CNICS, JHHCC, MASH, mSTUDY, and RADAR cohorts who had at least one visit between 2015 and 2024. We estimated prevalence ratios for HIV viral load non-suppression given current cannabis, crack/cocaine, methamphetamine/amphetamine, sedative, or opioid use. Current substance use was defined as any reported use occurring up to six months prior to the selected visit date. We estimated site-specific prevalence ratios and pooled estimates when they did not appear to be excessively heterogeneous. The analysis included data from 12,686 participants. Substance use was cross-sectionally associated with viral non-suppression. Current use of cannabis (PR: 1.18; 95% CI: 1.05, 1.30), opioids (PR: 1.74; 95% CI: 1.38, 2.10), cocaine (PR: 1.63; 95% CI: 1.28, 1.98), methamphetamine (PR: 2.57; 95% CI: 1.73, 3.42) and sedatives (PR: 1.50; 95% CI: 1.19, 1.81) were all associated with increased prevalence of viral non-suppression relative to no current use after covariate adjustment. Current drug use was associated with viral non-suppression in diverse samples of PWH. The results support efforts to better understand the association between substance use and HIV viral load across relevant subgroups of PWH, and to address the syndemic conditions of substance use and HIV.

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Publication Details

Journal
Substance Abuse Treatment Prevention and Policy
Published
2026-10-03
DOI
https://doi.org/10.1186/s13011-026-00766-x
Primary Topic
HIV/AIDS Research and Interventions
Type
article
Field-Weighted Citation Impact
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article

Associations between substance use by type and HIV viral suppression across multiple cohorts in the US

George A. Yendewa, Oluwaseun O Falade-Nwulia, Brian S. Mustanski, Catherine R. Lesko et al.
Substance Abuse Treatment Prevention and Policy
HIV/AIDS Research and Interventions
article

Associations between substance use by type and HIV viral suppression across multiple cohorts in the US

George A. Yendewa, Oluwaseun O Falade-Nwulia, Brian S. Mustanski, Catherine R. Lesko, Joseph A. Delaney, Joseph J. Eron, Pamina M. Gorbach, Kenneth Hugh Mayer, Ryan P. Kyle, Edward R. Cachay, Lydia N. Drumright, Raúl N. Mandler, Geetanjali Chander, Laura P Bamford, Heidi M. Crane, Michael S. Saag, Sonia Napravnik, Gregory Dale Kirk, Richard D. Moore, Robin M. Nance, Bridget M. Whitney, Katerina A. Christopoulos, Marianna K. Baum, Peter W. Hunt, Stephanie A. Meyers‐Pantele, Steven J. Shoptaw
article en

Abstract

Substance use among people with HIV (PWH) represents an important obstacle to further reductions in HIV transmission. Using data from a diverse collection of five studies including people with HIV in care and those in community cohorts, we report results for analyses of the association between substance use and HIV viral non-suppression. We analyzed data from participants from the CNICS, JHHCC, MASH, mSTUDY, and RADAR cohorts who had at least one visit between 2015 and 2024. We estimated prevalence ratios for HIV viral load non-suppression given current cannabis, crack/cocaine, methamphetamine/amphetamine, sedative, or opioid use. Current substance use was defined as any reported use occurring up to six months prior to the selected visit date. We estimated site-specific prevalence ratios and pooled estimates when they did not appear to be excessively heterogeneous. The analysis included data from 12,686 participants. Substance use was cross-sectionally associated with viral non-suppression. Current use of cannabis (PR: 1.18; 95% CI: 1.05, 1.30), opioids (PR: 1.74; 95% CI: 1.38, 2.10), cocaine (PR: 1.63; 95% CI: 1.28, 1.98), methamphetamine (PR: 2.57; 95% CI: 1.73, 3.42) and sedatives (PR: 1.50; 95% CI: 1.19, 1.81) were all associated with increased prevalence of viral non-suppression relative to no current use after covariate adjustment. Current drug use was associated with viral non-suppression in diverse samples of PWH. The results support efforts to better understand the association between substance use and HIV viral load across relevant subgroups of PWH, and to address the syndemic conditions of substance use and HIV.

Substance Abuse Treatment Prevention and Policy
Northwestern University (US), University of North Carolina at Chapel Hill (US), Beth Israel Deaconess Medical Center (US), National Institute on Drug Abuse (US), Johnson & Johnson (United States) (US), Harvard University (US), Johns Hopkins University (US), University of California, Los Angeles (US), University of California, San Francisco (US), Florida International University (US), University Hospitals of Cleveland (US), Harborview Medical Center (US), University of California System (US), University of Alabama at Birmingham (US), University of California San Diego (US), Neurobehavioral Systems (US), Johns Hopkins Hospital (US), UAB Medicine, Fenway Health (US)
Openalex Percentile: Top 12%
HIV/AIDS Research and Interventions
DOIOpen Access PDFOpenAlex
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