Background:
Pneumonia is common in persons living with the human immunodeficiency virus (HIV) (PLWH). Alcohol,
cocaine, and marijuana impact
pneumonia pathogenesis. We hypothesized that
substance use was independently associated with
pneumonia severity in PLWH and modified the effect of alcohol on
pneumonia severity. Methods: Retrospective data analysis of PLWH admitted with a diagnosis of
pneumonia was conducted.
Alcohol use disorder was defined by the
Alcohol Use Disorders Identification Test score ≥14.
Drug use was quantified by self-report.
Pneumonia severity was defined by the
pneumonia severity index (PSI). Multivariable linear regression was used to test independent associations with
pneumonia severity and effect modification by sex. Results: Of 196 PLWH, the mean age was 44 (SD = 9) years and the majority were men (71%). Ten percent (n = 19) of subjects met criteria for an
alcohol use disorder (AUD). In subjects reporting alcohol use, 25% reported concomitant
crack/cocaine use and 16% reported
marijuana use. PSI scores were higher with lifetime use of
crack/cocaine (mean PSI: 63.1 vs. 57.3, P = .06) and/or injection
drug use (68.4 vs. 54.9, P = .04). PSI scores were lower with active
marijuana use (51.5 vs. 62.2, P = .01). There was no significant difference in clinical outcomes. Sex modified the effect of
drug use on PSI, with greater PSI scores in women with an AUD (β = 58.1, 95% confidence interval [CI]: 46.7 to 69.5, P < .01), whereas active
marijuana use mitigated the effect of AUD on PSI in men (β = -12.7, 95% CI: -18.8 to -6.6, P < .01). Conclusions: Active alcohol and/or
crack/cocaine use was associated with increased
pneumonia severity in PLWH, with less severe
pneumonia with
marijuana use. Alcohol and marijuana effects on
pneumonia severity differed by sex, with increased PSI in women and decreased PSI in men with concomitant marijuana and AUD.