People living with HIV (PLWH) are disproportionately affected by mood, anxiety, and substance use disorders that prevent their sustained engagement with HIV care. Comprehensive research on the impact of these disorders on the HIV continuum of care is lacking. This study aimed to assess the impact of the syndemic between substance use disorder (SUD) and mood/anxiety disorders on the HIV continuum of care for PLWH in British Columbia (BC), Canada, and identify the stage with the highest attrition in the continuum. This retrospective population-based cohort study utilized data from the Comparative Outcomes And Service Utilization Trends (COAST) study that contains data on all diagnosed PLWH in BC. Eligible individuals were ≥ 19 years of age and were followed during 2001–2019. Our exposure variable was SUD or mood/anxiety disorder diagnoses. Our outcomes were the achievement of the following stages of the HIV continuum of care: (1) antiretroviral therapy (ART) initiation, (2) on-ART, (3) ART adherence, (4) viral suppression, and (5) maintained suppression. We estimated attrition by estimating the proportion of PLWH who proceed to each stage. Generalized linear mixed-effect models assessed the association between SUD and mood/anxiety disorders and the achievement of each stage while controlling for sociodemographic and HIV-related confounders. For the 14,398 eligible PLWH, maintained suppression exhibited the highest attrition. Having SUD or both SUD and mood/anxiety disorder were significantly associated with reduced odds of achieving all stages of the HIV continuum of care except on-ART. SUD had the strongest association with reduced odds of ART adherence (adjusted odds ratio (aOR) 0.47; 95% CI, 0.42–0.53) and reduced odds of maintained suppression (aOR 0.58; 95% CI, 0.53–0.63). Having only mood/anxiety disorders was also associated with reduced odds of both adherence (aOR 0.78; 95% CI, 0.71–0.87) and maintained suppression (aOR 0.82; 95% CI, 0.77–0.88). Our findings indicate that SUD and mood/anxiety disorders contribute to attritions across the continuum, emphasizing the need for integrated mental health and substance use services to support HIV care.

艾滋病毒感染者 (PLWH) 受到情绪、焦虑和药物滥用障碍的影响尤为严重，这些障碍阻碍了他们持续参与艾滋病毒护理。目前缺乏关于这些疾病对艾滋病毒连续护理影响的全面研究。本研究旨在评估物质使用障碍 (SUD) 和情绪/焦虑障碍之间的综合症对加拿大不列颠哥伦比亚省 (BC) 艾滋病毒感染者艾滋病毒感染者连续护理的影响，并确定连续护理中流失率最高的阶段。这项基于人群的回顾性队列研究利用了比较结果和服务利用趋势 (COAST) 研究的数据，该研究包含 BC 省所有诊断的 PLWH 的数据。符合资格的个体年龄≥19岁，并在2001年至2019年期间接受随访。我们的暴露变量是 SUD 或情绪/焦虑障碍诊断。我们的结果是实现了 HIV 连续护理的以下阶段：(1) 开始抗逆转录病毒治疗 (ART)，(2) 进行 ART，(3) 坚持 ART，(4) 病毒抑制，以及 (5) 维持治疗抑制。我们通过估计进入每个阶段的感染者的比例来估计人员流失情况。广义线性混合效应模型评估了 SUD 与情绪/焦虑障碍之间的关联以及每个阶段的成就，同时控制了社会人口统计学和艾滋病毒相关的混杂因素。对于 14,398 名符合条件的感染者和卫生人员来说，持续抑制表现出最高的流失率。患有 SUD 或同时患有 SUD 和情绪/焦虑障碍与实现 HIV 连续护理所有阶段（ART 除外）的几率降低显着相关。 SUD 与 ART 依从性降低（调整后优势比 (aOR) 0.47；95% CI，0.42-0.53）和维持抑制几率降低（aOR 0.58；95% CI，0.53-0.63）的相关性最强。仅患有情绪/焦虑障碍也与依从性（aOR 0.78；95% CI，0.71-0.87）和维持抑制（aOR 0.82；95% CI，0.77-0.88）的几率降低相关。我们的研究结果表明，SUD 和情绪/焦虑障碍会导致整个过程中的人员流失，强调需要综合心理健康和药物使用服务来支持艾滋病毒护理。