AIDS research and human retroviruses 2017 05 02() doi 10.1089/AID.2016.0274
Khat, a plant native to East Africa, has amphetamine-like psychoactive constituents, and is a potential risk factor for HIV infection. Chronic use can cause cognitive impairment and other mental disorders, raising concerns about effects on retention and adherence with HIV care. During 2013-14, 322 Ethiopian patients newly enrolled at HIV clinics in Dire Dawa and Harar were surveyed about khat use and prospectively followed for one year; 9% died, 18% transferred care to other clinics, and 22% were lost to follow-up (LTFU) (no clinic visit for >3 months). Of 248 patients who received a 12 month follow-up survey, 37% used khat in the year after enrollment, with a median use of 60 hours in a typical month. Those using khat >60 hours/month (median among users) were more likely that others to be LTFU (31% vs. 16%, p=0.014); those using khat >150 hours/month (upper quartile) had 44% LTFU rates vs. 16% for others (p=0.002). Complete 3-day adherence (taking all doses) of antiretroviral therapy was reported by 77% of those using khat >60 hours/month vs. 95% of all others (p<0.001), and 67% of those who using khat >150 hours/month vs. 94% of others (p<0.001). In two East African cities where khat use is common, frequent use was a significant risk factor for higher one-year LTFU and lower self-reported ART adherence among PLWH entering HIV care. Where khat is widely utilized, interventions to promote either non-use or reduced use are important as part of a comprehensive HIV care package and national HIV strategies.