INTRODUCTION: Evidence is needed to improve HIV treatment outcomes for individuals who use injection drugs (IDU). Although studies have suggested higher rates of plasma viral load (PVL) rebound among IDU on antiretroviral therapy (ART), risk factors for rebound have not been thoroughly investigated. METHODS: We used data from a long-running community-recruited prospective cohort of IDU in Vancouver, Canada, linked to comprehensive ART and clinical monitoring records. Using proportional hazards methods, we modeled the time to confirmed PVL rebound above 1000 copies per milliliter among IDU on ART with sustained viral suppression, defined as 2 consecutive undetectable PVL measures. RESULTS: Between 1996 and 2009, 277 individuals had sustained viral suppression. Over a median follow-up of 32 months, 125 participants (45.1%) experienced at least 1 episode of virologic failure for an incidence of 12.6 [95% confidence interval (CI): 10.5 to 15.0] per 100 person-years. In a multivariate model, PVL rebound was independently associated with sex-trade involvement [adjusted hazard ratio (AHR) = 1.40, 95% CI: 1.08 to 1.82) and recent incarceration (AHR = 1.83, 95% CI: 1.33 to 2.52). Methadone maintenance therapy (AHR = 0.79, 95% CI: 0.66 to 0.94) was protective. No measure of illicit drug use was predictive. CONCLUSIONS: In this setting of free ART, several social and environmental factors predicted higher risks of viral rebound among IDU, including sex-trade involvement and incarceration. These findings should help inform efforts to identify individuals at risk of viral rebound and targeted interventions to treat and retain individuals in effective ART.
INTRODUCTION: Evidence is needed to improve HIV treatment outcomes for individuals who use injection drugs (IDU). Although studies have suggested higher rates of plasma viral load (PVL) rebound among IDU on antiretroviral therapy (ART), risk factors for rebound have not been thoroughly investigated. METHODS: We used data from a long-running community-recruited prospective cohort of IDU in Vancouver, Canada, linked to comprehensive ART and clinical monitoring records. Using proportional hazards methods, we modeled the time to confirmed PVL rebound above 1000 copies per milliliter among IDU on ART with sustained viral suppression, defined as 2 consecutive undetectable PVL measures. RESULTS: Between 1996 and 2009, 277 individuals had sustained viral suppression. Over a median follow-up of 32 months, 125 participants (45.1%) experienced at least 1 episode of virologic failure for an incidence of 12.6 [95% confidence interval (CI): 10.5 to 15.0] per 100 person-years. In a multivariate model, PVL rebound was independently associated with sex-trade involvement [adjusted hazard ratio (AHR) = 1.40, 95% CI: 1.08 to 1.82) and recent incarceration (AHR = 1.83, 95% CI: 1.33 to 2.52). Methadone maintenance therapy (AHR = 0.79, 95% CI: 0.66 to 0.94) was protective. No measure of illicit drug use was predictive. CONCLUSIONS: In this setting of free ART, several social and environmental factors predicted higher risks of viral rebound among IDU, including sex-trade involvement and incarceration. These findings should help inform efforts to identify individuals at risk of viral rebound and targeted interventions to treat and retain individuals in effective ART.
Authors: Edward M Gardner; Shweta Sharma; Grace Peng; Katherine Huppler Hullsiek; William J Burman; Rodger D Macarthur; Margaret Chesney; Edward E Telzak; Gerald Friedland; Sharon B Mannheimer Journal: AIDS Date: 2008-01-02 Impact factor: 4.177
Authors: Kate Shannon; Steffanie A Strathdee; Jean Shoveller; Melanie Rusch; Thomas Kerr; Mark W Tyndall Journal: Am J Public Health Date: 2009-02-05 Impact factor: 9.308
Authors: Robert Gross; Benita Yip; Vincent Lo Re; Evan Wood; Christopher S Alexander; P Richard Harrigan; David R Bangsberg; Julio S G Montaner; Robert S Hogg Journal: J Infect Dis Date: 2006-09-12 Impact factor: 5.226
Authors: Roy M Gulick; Heather J Ribaudo; Cecilia M Shikuma; Christina Lalama; Bruce R Schackman; William A Meyer; Edward P Acosta; Jeffrey Schouten; Kathleen E Squires; Christopher D Pilcher; Robert L Murphy; Susan L Koletar; Margrit Carlson; Richard C Reichman; Barbara Bastow; Karin L Klingman; Daniel R Kuritzkes Journal: JAMA Date: 2006-08-16 Impact factor: 56.272
Authors: Evan Wood; Robert S Hogg; Viviane Dias Lima; Thomas Kerr; Benita Yip; Brandon D L Marshall; Julio S G Montaner Journal: JAMA Date: 2008-08-06 Impact factor: 56.272
Authors: C J Smith; A N Phillips; B Dauer; M A Johnson; F C Lampe; M S Youle; M Tyrer; S Staszewski Journal: HIV Med Date: 2008-11-10 Impact factor: 3.180
Authors: Steffanie A Strathdee; Remedios Lozada; Robin A Pollini; Kimberly C Brouwer; Andrea Mantsios; Daniela A Abramovitz; Tim Rhodes; Carl A Latkin; Oralia Loza; Jorge Alvelais; Carlos Magis-Rodriguez; Thomas L Patterson Journal: J Acquir Immune Defic Syndr Date: 2008-03-01 Impact factor: 3.731
Authors: Mary Clare Kennedy; Thomas H Kerr; Evan Wood; Jeannie A Shoveller; Julio S G Montaner; M-J S Milloy Journal: AIDS Date: 2018-05-15 Impact factor: 4.177