Farah Ladak1, Eugenia Socias2,3, Seonaid Nolan2,3, Huiru Dong2,4, Thomas Kerr2,3, Evan Wood2,3, Julio Montaner2,3, M-J Milloy1,2. 1. Department of General Surgery, University of Alberta, Edmonton, AB, Canada. 2. British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. 3. Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 4. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Abstract
BACKGROUND: Active illicit drug use can present a barrier to the medical management of HIV infection by complicating adherence to antiretroviral therapy (ART). Plasma HIV-1 RNA viral load (VL) rebound, defined as a period of detectable HIV VL following ART and VL suppression, can lead to the generation of viral resistance and potential treatment failure. We sought to investigate the contribution of substance use patterns on rates of VL rebound. METHODS: We used data from the ACCESS study, a long-running community-recruited prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, a setting of universal no-cost HIV treatment. We analysed time to VL rebound (that is, two consecutive observations ≥1,000 copies/ml) after ART initiation and sustained viral suppression (that is, two consecutive observations <50 copies/ml) using extended Cox regression models with a recurrent events framework. RESULTS: Between May 1996 and November 2013, 564 ART-exposed participants achieved at least one instance of VL suppression and contributed 1,893.8 person-years of observation. Over follow-up, 198 (35.1%) participants experienced ≥ one instance of VL rebound. In adjusted analyses, VL rebound was associated with younger age (adjusted hazard ratio [AHR] =0.97, 95% CI: 0.95, 0.98), heroin injection (≥ daily versus < daily, AHR =1.52, 95% CI: 1.01, 2.30), crack use (≥ daily versus < daily, AHR = 1.73, 95% CI: 1.08, 1.92) and heavy alcohol use (≥ four versus < four drinks/day, AHR =1.97, 95% CI: 1.17, 3.31). CONCLUSIONS: The present study suggests that in addition to heavy alcohol use, high-intensity illicit drug use, particularly ≥ daily heroin injection and ≥ daily crack smoking are risk factors for VL rebound. In addition to the impact of high-intensity drug use on health-care engagement and ART adherence, some evidence exists on the direct impact of psychoactive substances on ART metabolism and the natural progression of HIV disease. At-risk individuals should be provided additional supports to preserve virological control and maintain the benefits of ART.
BACKGROUND: Active illicit drug use can present a barrier to the medical management of HIV infection by complicating adherence to antiretroviral therapy (ART). Plasma HIV-1 RNA viral load (VL) rebound, defined as a period of detectable HIV VL following ART and VL suppression, can lead to the generation of viral resistance and potential treatment failure. We sought to investigate the contribution of substance use patterns on rates of VL rebound. METHODS: We used data from the ACCESS study, a long-running community-recruited prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, a setting of universal no-cost HIV treatment. We analysed time to VL rebound (that is, two consecutive observations ≥1,000 copies/ml) after ART initiation and sustained viral suppression (that is, two consecutive observations <50 copies/ml) using extended Cox regression models with a recurrent events framework. RESULTS: Between May 1996 and November 2013, 564 ART-exposed participants achieved at least one instance of VL suppression and contributed 1,893.8 person-years of observation. Over follow-up, 198 (35.1%) participants experienced ≥ one instance of VL rebound. In adjusted analyses, VL rebound was associated with younger age (adjusted hazard ratio [AHR] =0.97, 95% CI: 0.95, 0.98), heroin injection (≥ daily versus < daily, AHR =1.52, 95% CI: 1.01, 2.30), crack use (≥ daily versus < daily, AHR = 1.73, 95% CI: 1.08, 1.92) and heavy alcohol use (≥ four versus < four drinks/day, AHR =1.97, 95% CI: 1.17, 3.31). CONCLUSIONS: The present study suggests that in addition to heavy alcohol use, high-intensity illicit drug use, particularly ≥ daily heroin injection and ≥ daily crack smoking are risk factors for VL rebound. In addition to the impact of high-intensity drug use on health-care engagement and ART adherence, some evidence exists on the direct impact of psychoactive substances on ART metabolism and the natural progression of HIV disease. At-risk individuals should be provided additional supports to preserve virological control and maintain the benefits of ART.
Authors: Evan Wood; Robert S Hogg; Simon Bonner; Thomas Kerr; Kathy Li; Anita Palepu; Silvia Guillemi; Martin T Schechter; Julio S G Montaner Journal: JAMA Date: 2004-09-08 Impact factor: 56.272
Authors: M-J Milloy; Thomas Kerr; Jane Buxton; Tim Rhodes; Andrea Krusi; Silvia Guillemi; Robert Hogg; Julio Montaner; Evan Wood Journal: J Acquir Immune Defic Syndr Date: 2012-04-01 Impact factor: 3.731
Authors: Yuan Li; Jeffrey D Merrill; Kathy Mooney; Li Song; Xu Wang; Chang-Jiang Guo; Rashmin C Savani; David S Metzger; Steven D Douglas; Wen-Zhe Ho Journal: Pediatr Res Date: 2003-05-07 Impact factor: 3.756
Authors: Leonn Mendes Soares Pereira; Eliane Dos Santos França; Iran Barros Costa; Igor Tenório Lima; Amaury Bentes Cunha Freire; Francisco Lúzio de Paula Ramos; Talita Antonia Furtado Monteiro; Olinda Macedo; Rita Catarina Medeiros Sousa; Felipe Bonfim Freitas; Igor Brasil Costa; Antonio Carlos Rosário Vallinoto Journal: Sci Rep Date: 2021-09-16 Impact factor: 4.996
Authors: Sheri D Weiser; Lila A Sheira; Kartika Palar; Margot Kushel; Tracey E Wilson; Adebola Adedimeji; Dan Merenstein; Mardge Cohen; Janet M Turan; Lisa Metsch; Adaora A Adimora; Ighovwerha Ofotokun; Eryka Wentz; Phyllis C Tien; Edward A Frongillo Journal: AIDS Patient Care STDS Date: 2020-09-17 Impact factor: 5.078
Authors: Gregory D Kirk; Jacqueline Astemborski; Shruti H Mehta; Kristen D Ritter; Gregory M Laird; Rebeka Bordi; Rafick Sekaly; Janet D Siliciano; Robert F Siliciano Journal: J Infect Dis Date: 2021-06-04 Impact factor: 5.226
Authors: Casey D Xavier Hall; Ethan Morgan; Camille Bundy; James E Foran; Patrick Janulis; Michael E Newcomb; Brian Mustanski Journal: AIDS Behav Date: 2021-02-13
Authors: Becky L Genberg; Gregory D Kirk; Jacquie Astemborski; Hana Lee; Noya Galai; Kenrad E Nelson; David Vlahov; David D Celentano; Shruti H Mehta Journal: Am J Epidemiol Date: 2019-12-31 Impact factor: 5.363
Authors: Susmita Sil; Annadurai Thangaraj; Ernest T Chivero; Fang Niu; Muthukumar Kannan; Ke Liao; Peter S Silverstein; Palsamy Periyasamy; Shilpa Buch Journal: Neurosci Lett Date: 2021-03-29 Impact factor: 3.197
Authors: Jason A Craw; Linda Beer; Yunfeng Tie; Tom Jaenicke; R Luke Shouse; Joseph Prejean Journal: J Acquir Immune Defic Syndr Date: 2020-06-01 Impact factor: 3.771