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Brief Report

Reduced Use of Illicit Substances, Even Without Abstinence, Is Associated With Improved Depressive Symptoms Among People Living With HIV

Delaney, Joseph A. PhD*; Nance, Robin M. MS*,†; Whitney, Bridget M. MPH*; Altice, Frederick L. PhD; Dong, Xinyuan MS§; Trejo, Maria Esther Perez PhD§; Matsuzaki, Mika PhD§; Taxman, Faye S. PhD; Chander, Geetanjali MD; Kuo, Irene PhD#; Fredericksen, Rob PhD**; Strand, Lauren N. MS††; Eron, Joseph J. MD‡‡; Geng, Elvin MD§§; Kitahata, Mari M. MD**; Mathews, William C. MD║║; Mayer, Kenneth MD¶¶; Moore, Richard D. MD##; Saag, Michael S. MD***; Springer, Sandra MD†††; Chandler, Redonna PhD‡‡‡; Kahana, Shoshana PhD‡‡‡; Crane, Heidi M. MD**

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1, 2018 - Volume 79 - Issue 3 - p 283–287
doi: 10.1097/QAI.0000000000001803

Purpose: Substance use is linked with poor outcomes among people living with HIV (PLWH) and is associated with mental health disorders. This analysis examines the impact of decreasing substance use, even without abstinence, on depressive symptoms among PLWH.

Methods: Data are from PLWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Sites cohort. Participants completed longitudinal assessments of substance use (modified ASSIST) and depressive symptoms (PHQ-9). Changes in substance use frequency were categorized as abstinence, reduced use, and nondecreasing use. Adjusted linear mixed models with time-updated change in substance use frequency and depressive symptom scores were used to examine associations between changes in the use of individual substances and depressive symptoms. Analyses were repeated using joint longitudinal survival models to examine associations with a high (PHQ-9 ≥10) score.

Results: Among 9905 PLWH, 728 used cocaine/crack, 1016 used amphetamine-type substances (ATS), 290 used illicit opiates, and 3277 used marijuana at baseline. Changes in ATS use were associated with the greatest improvements in depressive symptoms: stopping ATS led to a mean decrease of PHQ-9 by 2.2 points (95% CI: 1.8 to 2.7) and a 61% lower odds of PHQ-9 score ≥10 (95% CI: 0.30 to 0.52), and decreasing ATS use led to a mean decrease of 1.7 points (95% CI: 1.2 to 2.3) and a 62% lower odds of PHQ-9 score ≥10 (95% CI: 0.25 to 0.56). Stopping and reducing marijuana and stopping cocaine/crack use were also associated with improvement in depressive symptoms.

Conclusions: We demonstrated that both substance use reduction and abstinence are associated with improvements in depressive symptoms over time.

*Epidemiology, University of Washington, Seattle, WA;

Medicine and Epidemiology, University of Washington, Seattle, WA;

Medicine and Epidemiology, Yale School of Medicine, New Haven, CT;

§Biostatistics, University of Washington, Seattle, WA;

Criminology, Law and Society, George Mason University, Fairfax, VA;

Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD;

#Epidemiology, Johns Hopkins University, Baltimore, MD;

**Medicine, University of Washington, Seattle, WA;

††Pharmacy, University of Washington, Seattle, WA;

‡‡Medicine and Epidemiology, University of North Carolina, Chapel Hill, NC;

§§Medicine, University of California San Francisco, San Francisco, CA;

║║Clinical Medicine, University of California San Diego, San Diego, CA;

¶¶Global Health and Population, Harvard University, Boston, MA;

##Medicine, Johns Hopkins University, Baltimore, MD;

***Medicine, University of Alabama, Birmingham, AL;

†††Medicine and Nursing, Yale School of Medicine, New Haven, CT; and

‡‡‡National Institute of Drug Abuse, Washington, DC.

Correspondence to: Joseph A. Delaney, Collaborative Health Studies Coordinating Center, 6200 NE 74th Street, Building 29, Suite 210, University of Washington, Box 354922, Seattle, WA 98115 (e-mail:

Supported by U01DA037702 from the National Institute on Drug Abuse (NIDA). Primary data collection was supported by grants R01DA030768, R01 DA030768, and R24 AI067039. Additional support came from the National Institutes of Alcohol Abuse and Alcoholism (NIAAA) [U24AA020801, U01AA020793, and U01AA020802] and from the National Institute of Allergy and Infectious Diseases (NIAID) [CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757; UNC CFAR grant P30 AI50410, JHU CFAR grant P30 AI094189, and UAB CFAR grant P30 AI027767]. The authors thank the other investigators, the staff, and particularly the participants of the individual STTR studies for their valuable contributions. A full list of participating STTR investigators and institutions can be found at

The authors have no funding or conflicts of interest to disclose.

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Received March 06, 2018

Accepted June 27, 2018

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