Ongoing drug use and outcomes from highly active antiretroviral therapy among injection drug users in a Canadian setting

British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
Antiviral therapy (Impact Factor: 3.02). 01/2010; 15(5):789-96. DOI: 10.3851/IMP1614
Source: PubMed


The effect of ongoing illicit drug use on HIV treatment remains controversial, especially in countries where access to HIV treatment for active injection drug users (IDUs) is limited because of presumed non-adherence. We sought to investigate the influence of drug use patterns on adherence to antiretroviral therapy and virological suppression among IDUs.
Using generalized estimating equation logistic regression, we explored the effect of abstinence versus ongoing drug use on adherence and virological suppression using data from a community-recruited cohort of IDUs in Vancouver (BC, Canada).
A total of 381 HIV-positive IDUs were included in this analysis, among whom the median follow-up time was 30 months. In a multivariate model, no relationship was found between abstinence (reference) and active injection (adjusted odds ratio [AOR] 0.88, 95% confidence interval [CI] 0.65-1.17) and non-injection (AOR 0.97, 95% CI 0.67-1.41) drug use with adherence. In subanalyses, ongoing injection drug use was associated with a lower odds of virological suppression in comparison to abstinence (AOR 0.74, 95% CI 0.57-0.97; P=0.026) and both active IDUs and active non-IDUs had lower odds of virological suppression compared with abstinent participants when longer periods of virological suppression were considered.
Given the absence of a strong relationship between abstinence and ongoing drug use and adherence among HIV-positive IDUs, programmes that restrict antiretrovirals to abstinent individuals should be re-examined. The lower rates of virological suppression associated with ongoing drug use nevertheless highlight the importance of comprehensive systems of care and addiction treatment for active drug users.

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    • "In the test of the first hypothesis, the primary outcome of interest was detectable VL in the previous six months, defined as >500 RNA copies/mL plasma. This value was used as it is the lowest level available throughout the study period and is the same as previous analyses of VL from our setting [28,29]. HIV clinical monitoring data was gathered using each participant’s PHN through the confidential linkage described above and included all VL and CD4+ measurements conducted through the study as well as any VL/CD4+ tests conducted outside of the study setting, for example, by a participant’s personal physician. "
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    ABSTRACT: Informed by recent studies demonstrating the central role of plasma HIV-1 RNA viral load (VL) on HIV transmission, interventions to employ HIV antiretroviral treatment as prevention (TasP) are underway. To optimize these efforts, evidence is needed to identify factors associated with both non-suppressed VL and HIV risk behaviours. Thus, we sought to assess the possible role played by exposure to correctional facilities on VL non-suppression and used syringe lending among HIV-seropositive people who use injection drugs (PWID). We used data from the ACCESS study, a community-recruited prospective cohort. We used longitudinal multivariate mixed-effects analyses to estimate the relationship between incarceration and plasma HIV-1 RNA > 500 copies/mL among antiretroviral therapy (ART)-exposed active PWID and, during periods of non-suppression, the relationship between incarceration and used syringe lending. Between May 1996 and March 2012, 657 ART-exposed PWID were recruited. Incarceration was independently associated with higher odds of VL non-suppression (Adjusted Odds Ratio [AOR] = 1.54, 95% Confidence Interval [95% CI]: 1.10, 2.16). In a separate multivariate model restricted to periods of VL non-suppression, incarceration was independently associated with lending used syringes (AOR = 1.81, 95% CI: 1.03, 3.18). The current findings demonstrate that incarceration is associated with used syringe lending among active PWID with detectable plasma HIV-1 RNA. Our results provide a possible pathway for the commonly observed association between incarceration and increased risk of HIV transmission. Our results suggest that alternatives to incarceration of non-violent PWID and evidence-based combination HIV prevention interventions for PWID within correctional facilities are urgently needed.
    BMC Infectious Diseases 12/2013; 13(1):565. DOI:10.1186/1471-2334-13-565 · 2.61 Impact Factor
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    • "A small number of studies have revealed adverse effects of crack cocaine use (Moss et al., 2004; Sullivan et al., 2007) (Baum et al., 2009) and stimulant use more generally (Hinkin et al., 2007; Kapadia et al., 2005) on adherence and progression to AIDS. However, we know of no longitudinal studies that have sought to compare the distinct effects of different drugs on outcomes associated with the treatment of HIV disease, despite recent calls for this type of research (Krüsi et al., 2010). In addition, questions remain concerning the relative contributions of other behavioral factors to poor clinical outcomes among IDU (Krüsi et al., 2010; Wood et al., 2008). "
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    ABSTRACT: Previous studies suggest that active drug use may compromise HIV treatment among HIV-positive injection drug users (IDU). However, little is known about the differential impacts of cocaine injection, heroin injection, and combined cocaine and heroin injection on plasma HIV-1 RNA suppression. Data were derived from a longstanding open prospective cohort of HIV-positive IDU in Vancouver, Canada. Kaplan-Meier methods and Cox proportional hazards regression were used to examine the impacts of different drug use patterns on rates of plasma HIV-1 RNA suppression. Between May 1996 and April 2008, 267 antiretroviral (ART) naïve participants were seen for a median follow-up duration of 50.6 months after initiating ART. The incidence density of HIV-1 RNA suppression was 65.2 (95%CI: 57.0-74.2) per 100 person-years. In Kaplan-Meier analyses, compared to those who abstained from injecting, individuals injecting heroin, cocaine, or combined heroin/cocaine at baseline were significantly less likely to achieve viral suppression (all p<0.01). However, none of the drug use categories remained associated with a reduced rate of viral suppression when considered as time-updated variables (all p>0.05). Active injecting at the time of ART initiation was associated with lower plasma HIV-1 RNA suppression rates; however, there was no difference in suppression rates when drug use patterns were examined over time. These findings imply that adherence interventions for active injectors should optimally be applied at the time of ART initiation.
    Drug and alcohol dependence 01/2012; 124(1-2):108-12. DOI:10.1016/j.drugalcdep.2011.12.019 · 3.42 Impact Factor
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    JAIDS Journal of Acquired Immune Deficiency Syndromes 12/2010; 55 Suppl 1:S1-4. DOI:10.1097/QAI.0b013e3181f9c120 · 4.56 Impact Factor
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