Background: HIV viral suppression is an important indicator of effective HIV treatment, and decreases the likelihood of transmission. Substance use (SU) can negatively impact HIV-positive individuals'' care engagement, including a higher likelihood of viremia and transmission. Therefore, it is important to understand the relationship between SU, SU treatment, and viral suppression.
Methods: Data from 2512 women were collected during six semiannual visits (10/2013-09/2016) at nine Women''s Interagency HIV Study (WIHS) sites-WIHS is the largest U.S. cohort study of HIV-positive and HIV-negative women. We compared the use of single substances and SU treatment indicators to viral suppression, and then used latent class analyses of these domains to predict viral suppression.
Results: Substance use patterns were similar across HIV-positive and HIV-negative women. Among HIV-positive women, bivariate models by substance type found that stimulant users had the largest difference in viral suppression between users and non-users (74% versus 82%). In latent class analysis, individuals with consistent use of stimulants, marijuana and binge drinking had the lowest percentage of suppression (62%), with those consistently using all substances with the next lowest percentage (69%). The class that predominately used marijuana (82% virally suppressed) and the class with very low use of any substance (85% virally suppressed) had the highest rates. The interaction of SU and SU treatment classes showed that the rate of virally suppressed individuals in the Low-SU and No-SU-Treatment classes increased from 81% to 88% (baseline to 30 months), whereas the Declining-Use class and all classes including stimulants who were also in the No-SU treatment class had a decreased likelihood of viral suppression from baseline to 30 months. Individuals in Increasing-Professional-Treatment who used stimulants and other substances had the lowest viral suppression at baseline (36%) but also greater increases (13%) than the Low-Use/No-SU-Treatment individuals. Consistent Alcoholics/Narcotics Anonymous (AA/NA) attendance was associated with higher rates of viral suppression across all substance use classes.
Conclusions: Substance using women who attended treatment showed improvement in HIV viral suppression rates relative to those not in treatment. Latent class analysis provides a sharper picture of how specific patterns of SU and SU treatment affect HIV-positive women''s maintenance of viral suppression.

Substance Use Over Time: 7-Class Solution
[Substance Use Over Time: 7-Class Solution]

Percent Virally SuppressedSubstance Use Treatment Classes
 Increasing Professional Treatment/ No AA/NADecreasing TreatmentLow Professional Treatment/ High AA/NANo SU Treatment
Substance Use ClassesBaseline30 MonthsBaseline30 MonthsBaseline30 MonthsBaseline30 Months
Declining Use55%69%70%82%68%96%73%69%
Mostly Marijuana + Marijuana & Binge + Binge Drinkers89%83%50%77%98%99%75%84%
Stimulants, Marijuana & Binge Drinking + Uses All Substances36%49%70%68%24%88%68%64%
Low Use64%78%80%78%90%95%81%88%
[Percent viral suppression by substance use classes and substance use treatment classes]

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