People living with HIV who inject or have injected non-prescription drugs: Evidence of substantial differences in health inequalities and experiences of clinical care

Neuropsychiatric adverse events in people with HIV initiating a new integrase strand transfer inhibitor-based regimen in Italy: findings from the NEURO-INSTI study

BACKGROUND

Although clinical trials reported a low and comparable rate of central nervous system (CNS)/neuropsychiatric (NP) disturbances among people with HIV (PWH) receiving integrase strand transfer inhibitors (INSTI) or other antiretroviral therapy (ART), higher rates of these disturbances have been reported in clinical practice. Our aim was to compare the occurrence of CNS-NP disorders in the different INSTI drugs.

METHODS

Using data from the SCOLTA project, a multicenter observational study following PWH who start antiretrovirals to identify adverse events (AEs) in real-life, we performed a retrospective analysis (NEURO-INSTI) to assess incidence rates (IRs) and 95% confidence intervals (95% CI) of CNS/NP AEs and related interruptions. Observation was truncated at the first occurrence of any CNS/NP AEs, even if not causing treatment discontinuation. IRs were calculated as number of first occurrences/100 person-years follow-up (PYFU). To identify risk factors for CNS/NP AEs occurrence, a Cox regression analysis for competing risks was used (hazard ratio, HR, and 95% CI), including variables associated with the outcome at a p level < 0.20 in the univariate analysis.

RESULTS

We analyzed a sample of 2,922 PWH (mean age 47.2 years, 74.7% males) enrolled in raltegravir (RAL), dolutegravir (DTG), elvitegravir (EVG), and bictegravir (BIC) INSTI-cohorts since 2007. Over a median observation time of 28 months (interquartile range 14-45), 126 CNS/NP AEs and 72 related discontinuations occurred; IRs were 1.59/100 PYFU (95% CI, 1.34-1.90) and 0.91/100 PYFU (95% CI 0.72-1.15), respectively. In multivariate models, intravenous drug use history (IVDUh), current abacavir use, RAL use, and psychiatric illnesses were associated with a higher risk of CNS/NP AEs. IVDUh and current abacavir use were also associated with treatment discontinuation. Using an INSTI as a first-line therapy and starting with CD4 ≥ 350 cell/µL also increased the likelihood of discontinuation. Compared to DTG, BIC and EVG showed lower risks of CNS/NP AEs (adjusted HR 0.27, 95% CI 0.10-0.74, and 0.51, 95% CI 0.22-1.20, respectively), while RAL showed a higher risk (aHR 2.52, 95% CI 1.57-4.05).

CONCLUSIONS

Among PWH on INSTI treatment, IVDUh, concurrent psychiatric illness, abacavir and RAL use increased the risk of CNS/NP AEs occurrence. PWH on BIC were less likely to experience CNS/NP AEs and related treatment discontinuations.

Typologies of alcohol and other drug-related risk among lesbian, gay, bisexual, transgender (trans) and queer adults

INTRODUCTION

Prevalence and patterns of alcohol and other drug (AOD) use among specific lesbian, gay, bisexual, transgender (trans) and queer (LGBTQ+) subpopulations are well established. However, patterns of substance-related risk have been less thoroughly explored. This study aimed to determine typologies AOD risk among LGBTQ+ adults in Australia.

METHOD

Latent class analyses were performed to determine distinct patterns of AOD risk (n = 6835), as measured by the Alcohol Use Disorder Identification Test and Drug Abuse Screening Tool. Demographic characteristics, experience of harassment, assault and/or threats, mental wellbeing and LGBTQ+ connectedness were compared across emergent classes.

RESULTS

AOD risk was characterised as 'no risk' (13.3% of sample), 'low risk' (15.1%), 'moderate risk' (alcohol + other drugs; 30.1%), or 'moderate alcohol only risk' (41.5%). The 'moderate risk' class was the most likely class to report recent sexual assault, verbal abuse, harassment and physical threats compared to other classes, while those in the 'moderate alcohol only risk' group were least likely to report these experiences of all classes. However, both the 'moderate risk' and 'moderate alcohol risk only' classes reported greater mental wellbeing and LGBTQ+ connectedness compared to the 'no risk' and 'low risk' classes.

DISCUSSION AND CONCLUSIONS

Our findings indicate that level of AOD risk is not uniform among some LGBTQ+ adults, nor is the distribution of harms experienced by them. Tailored harm-reduction interventions may be fruitful in attenuating harms based on risk profile; most specifically, LGBTQ+ individuals engaging in moderately risky concurrent AOD use.