Association of Substance Use With Hospitalization and Virologic Suppression in a Southern Academic HIV Clinic

Abstract

Background: Persons with HIV infection who do not achieve virologic suppression contribute significantly to the ongoing HIV epidemic and have an increased risk of clinical sequelae related to immunosuppression. The extent to which substance use and mental health diagnoses affect HIV outcomes and the care continuum has not been previously assessed at the Medical University of South Carolina (MUSC), a large academic HIV clinic.

Methods: To address this knowledge gap and identify targets for intervention, we performed a retrospective chart review to examine associations of substance use and mental health diagnoses with hospitalization and virologic suppression.

Results: Patients with substance use or mental health diagnoses had increased rates of hospitalization and lower rates of sustained longitudinal HIV suppression. Prevalence of distinct substance-related disorders differed by race and sex. Although cocaine, alcohol and cannabis use were common, documented opiate use disorder was surprisingly infrequent given the ongoing opioid epidemic in South Carolina.

Conclusions: These data suggest effective assessment and treatment of substance use disorders will help improve the HIV care continuum in South Carolina.

Keywords: Electronic medical record; HIV; HIV care continuum; Mental health disorder; Substance use disorder.