Abstract
BACKGROUND: Concomitant use of cocaine and HIV pre-exposure prophylaxis (PrEP) raises important clinical questions around adherence, retention in care, and renal toxicity. METHODS: We assessed the associations of confirmed cocaine use with PrEP adherence (both ascertained through objective measures), care engagement, and renal function in the iPrEx open-label extension. Cocaine use was measured in scalp hair samples and categorized as light (500-3000 pg/mg) and moderate to heavy (>3000 pg/mg). PrEP adherence in the first 3 months was measured through plasma tenofovir concentrations. Disengagement from PrEP care was defined as a gap in follow-up greater than 4 months. Serum creatinine was assessed at baseline and quarterly visits. RESULTS: Of the 400 participants included in this analysis, 90% were men who have sex with men, 10% transgender women, 74% Hispanic/Latino; 21% tested positive for cocaine use in the last 3 months. In adjusted analysis, light cocaine use [adjusted odds ratio 2.10 (95% confidence interval: 1.07 to 4.14)] and moderate to heavy use [adjusted odds ratio 2.32 (1.08 to 5.00)] were associated with greater odds of having plasma tenofovir concentrations below the level of quantitation. Participants with moderate to heavy use had a nearly 3-fold higher rate of disengagement from PrEP care compared with nonusers (adjusted hazard ratio 2.90 [1.48 to 5.66]). We found no statistically or clinically significant differences in creatinine clearance and serum creatinine between participants who tested positive for cocaine and those who did not. CONCLUSIONS: Cocaine use decreases PrEP adherence and care engagement. Comprehensive approaches are needed to reduce cocaine use and enhance engagement along the PrEP care continuum.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 78-82 |
| Number of pages | 5 |
| Journal | Journal of acquired immune deficiency syndromes (1999) |
| Volume | 81 |
| Issue number | 1 |
| DOIs | |
| State | Published - May 1 2019 |
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ASJC Scopus subject areas
- Infectious Diseases
- Pharmacology (medical)
Cite this
Brief Report : Cocaine Use and Pre-exposure Prophylaxis: Adherence, Care Engagement, and Kidney Function. / Hojilla, Jose Carlo; Satre, Derek D.; Glidden, David V.; McMahan, Vanessa M.; Gandhi, Monica; Defechereux, Patricia; Guanira, Juan V.; Mehrotra, Megha; Grant, Robert M.; Carrico, Adam.
In: Journal of acquired immune deficiency syndromes (1999), Vol. 81, No. 1, 01.05.2019, p. 78-82.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Brief Report
T2 - Cocaine Use and Pre-exposure Prophylaxis: Adherence, Care Engagement, and Kidney Function
AU - Hojilla, Jose Carlo
AU - Satre, Derek D.
AU - Glidden, David V.
AU - McMahan, Vanessa M.
AU - Gandhi, Monica
AU - Defechereux, Patricia
AU - Guanira, Juan V.
AU - Mehrotra, Megha
AU - Grant, Robert M.
AU - Carrico, Adam
PY - 2019/5/1
Y1 - 2019/5/1
N2 - BACKGROUND: Concomitant use of cocaine and HIV pre-exposure prophylaxis (PrEP) raises important clinical questions around adherence, retention in care, and renal toxicity. METHODS: We assessed the associations of confirmed cocaine use with PrEP adherence (both ascertained through objective measures), care engagement, and renal function in the iPrEx open-label extension. Cocaine use was measured in scalp hair samples and categorized as light (500-3000 pg/mg) and moderate to heavy (>3000 pg/mg). PrEP adherence in the first 3 months was measured through plasma tenofovir concentrations. Disengagement from PrEP care was defined as a gap in follow-up greater than 4 months. Serum creatinine was assessed at baseline and quarterly visits. RESULTS: Of the 400 participants included in this analysis, 90% were men who have sex with men, 10% transgender women, 74% Hispanic/Latino; 21% tested positive for cocaine use in the last 3 months. In adjusted analysis, light cocaine use [adjusted odds ratio 2.10 (95% confidence interval: 1.07 to 4.14)] and moderate to heavy use [adjusted odds ratio 2.32 (1.08 to 5.00)] were associated with greater odds of having plasma tenofovir concentrations below the level of quantitation. Participants with moderate to heavy use had a nearly 3-fold higher rate of disengagement from PrEP care compared with nonusers (adjusted hazard ratio 2.90 [1.48 to 5.66]). We found no statistically or clinically significant differences in creatinine clearance and serum creatinine between participants who tested positive for cocaine and those who did not. CONCLUSIONS: Cocaine use decreases PrEP adherence and care engagement. Comprehensive approaches are needed to reduce cocaine use and enhance engagement along the PrEP care continuum.
AB - BACKGROUND: Concomitant use of cocaine and HIV pre-exposure prophylaxis (PrEP) raises important clinical questions around adherence, retention in care, and renal toxicity. METHODS: We assessed the associations of confirmed cocaine use with PrEP adherence (both ascertained through objective measures), care engagement, and renal function in the iPrEx open-label extension. Cocaine use was measured in scalp hair samples and categorized as light (500-3000 pg/mg) and moderate to heavy (>3000 pg/mg). PrEP adherence in the first 3 months was measured through plasma tenofovir concentrations. Disengagement from PrEP care was defined as a gap in follow-up greater than 4 months. Serum creatinine was assessed at baseline and quarterly visits. RESULTS: Of the 400 participants included in this analysis, 90% were men who have sex with men, 10% transgender women, 74% Hispanic/Latino; 21% tested positive for cocaine use in the last 3 months. In adjusted analysis, light cocaine use [adjusted odds ratio 2.10 (95% confidence interval: 1.07 to 4.14)] and moderate to heavy use [adjusted odds ratio 2.32 (1.08 to 5.00)] were associated with greater odds of having plasma tenofovir concentrations below the level of quantitation. Participants with moderate to heavy use had a nearly 3-fold higher rate of disengagement from PrEP care compared with nonusers (adjusted hazard ratio 2.90 [1.48 to 5.66]). We found no statistically or clinically significant differences in creatinine clearance and serum creatinine between participants who tested positive for cocaine and those who did not. CONCLUSIONS: Cocaine use decreases PrEP adherence and care engagement. Comprehensive approaches are needed to reduce cocaine use and enhance engagement along the PrEP care continuum.
UR - http://www.scopus.com/inward/record.url?scp=85064721751&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064721751&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000001972
DO - 10.1097/QAI.0000000000001972
M3 - Article
C2 - 30730359
AN - SCOPUS:85064721751
VL - 81
SP - 78
EP - 82
JO - Journal of acquired immune deficiency syndromes (1999)
JF - Journal of acquired immune deficiency syndromes (1999)
SN - 1525-4135
IS - 1
ER -