Social and Environmental Predictors of Plasma HIV RNA Rebound Among Injection Drug Users Treated With Antiretroviral Therapy

Milloy, MJ; Kerr, T; Buxton, J; Rhodes, T; Krusi, A; Guillemi, S; Hogg, R; Montaner, J; Wood, E; (2012) Social and Environmental Predictors of Plasma HIV RNA Rebound Among Injection Drug Users Treated With Antiretroviral Therapy. Journal of acquired immune deficiency syndromes (1999), 59 (4). pp. 393-399. ISSN 1525-4135 DOI:

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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.

Item Type: Article
Keywords: antiretroviral therapy, human immunodeficiency virus infection, injection drug user, plasma HIV-1 RNA viral load, viral rebound, viral, suppression, virological response, medication adherence, infected prisoners, viral, suppression, initial treatment, substance-abuse, haart access, sex, workers, failure, incarceration, Adult, Anti-HIV Agents, therapeutic use, Antiretroviral Therapy, Highly Active, British Columbia, Female, HIV Infections, blood, drug therapy, HIV-1, drug effects, Humans, Male, Methadone, therapeutic use, Middle Aged, Opiate Substitution Treatment, Prisoners, Prospective Studies, Prostitution, RNA, Viral, blood, Substance Abuse, Intravenous, complications, virology, Viral Load, drug effects
Faculty and Department: Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
PubMed ID: 22134149
Web of Science ID: 301416100018


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