Brief Report: Cocaine Use and Pre-exposure Prophylaxis: Adherence, Care Engagement, and Kidney Function

Jose Carlo Hojilla, Derek D. Satre, David V. Glidden, Vanessa M. McMahan, Monica Gandhi, Patricia Defechereux, Juan V. Guanira, Megha Mehrotra, Robert M. Grant, Adam Carrico

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)78-82
Number of pages5
JournalJournal of acquired immune deficiency syndromes (1999)
Volume81
Issue number1
DOIs
StatePublished - May 1 2019

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Cocaine
Kidney
Tenofovir
Creatinine
Hispanic Americans
Odds Ratio
Transgender Persons
Light
Continuity of Patient Care
Pre-Exposure Prophylaxis
Scalp
Serum
Hair
HIV
Confidence Intervals

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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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 journalArticle

Hojilla, JC, Satre, DD, Glidden, DV, McMahan, VM, Gandhi, M, Defechereux, P, Guanira, JV, Mehrotra, M, Grant, RM & Carrico, A 2019, 'Brief Report: Cocaine Use and Pre-exposure Prophylaxis: Adherence, Care Engagement, and Kidney Function', Journal of acquired immune deficiency syndromes (1999), vol. 81, no. 1, pp. 78-82. https://doi.org/10.1097/QAI.0000000000001972
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. / Brief Report : Cocaine Use and Pre-exposure Prophylaxis: Adherence, Care Engagement, and Kidney Function. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 81, No. 1. pp. 78-82.
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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.

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