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Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users.
CMAJ. 2003 Sep 30; 169(7):656-61.CMAJ

Abstract

BACKGROUND

The benefits of highly active antiretroviral therapy (HAART) for the treatment of HIV infection are well documented, but concerns regarding access and adherence to HAART are growing. We evaluated virological responses to HAART among HIV-1 infected patients who were injection drug users (IDUs) in a population-based setting where HIV/AIDS care is delivered free of charge.

METHODS

We evaluated previously untreated HIV-1 infected men and women who initiated HAART between Aug. 1, 1996, and July 31, 2000, and who were followed until Mar. 31, 2002, in a province-wide HIV treatment program. We used Kaplan-Meier methods and Cox proportional hazards regression in our evaluation of time to suppression (i.e., less than 500 copies/mL) and rebound (i.e., 500 copies/mL or more) of plasma HIV-1 RNA, with patients stratified according to whether or not they had a history of injection drug use.

RESULTS

Overall, 1422 patients initiated HAART during the study period, of whom 359 (25.2%) were IDUs. In Kaplan-Meier analyses, the cumulative suppression rate at 12 months after initiation of HAART was 70.8% for non-IDUs and 51.4% for IDUs (p < 0.001) (these values include people who achieved suppression before 12 months but who might not have been followed for the full 12-month period). Among patients who achieved suppression of plasma HIV-1 RNA, the cumulative rebound rate at 12 months after initial suppression was 23.8% for non-IDUs and 34.7% for IDUs (p < 0.001). However, after adjustment for adherence and other covariates, the rates of HIV-1 RNA suppression (adjusted relative hazard 0.9, 95% confidence interval [CI] 0.7-1.0) and HIV-1 RNA rebound (adjusted relative hazard 1.3, 95% CI 1.0-1.6) were similar between non-IDUs and IDUs. Differences between non-IDUs and IDUs were even less pronounced in subanalyses that considered only therapy-adherent patients (p > 0.1).

INTERPRETATION

Non-IDUs and IDUs had similar rates of HIV-1 RNA suppression and rebound after the initiation of HAART, once lower levels of adherence were taken into account. Nevertheless, the lower virological response rates among IDUs suggest that, unless interventions are undertaken to improve adherence, these patients may experience elevated rates of disease progression and use of medical services in our setting.

Authors+Show Affiliations

British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC. ewood@hivnet.ubc.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14517122

Citation

Wood, Evan, et al. "Adherence and Plasma HIV RNA Responses to Highly Active Antiretroviral Therapy Among HIV-1 Infected Injection Drug Users." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 169, no. 7, 2003, pp. 656-61.
Wood E, Montaner JS, Yip B, et al. Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ. 2003;169(7):656-61.
Wood, E., Montaner, J. S., Yip, B., Tyndall, M. W., Schechter, M. T., O'Shaughnessy, M. V., & Hogg, R. S. (2003). Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 169(7), 656-61.
Wood E, et al. Adherence and Plasma HIV RNA Responses to Highly Active Antiretroviral Therapy Among HIV-1 Infected Injection Drug Users. CMAJ. 2003 Sep 30;169(7):656-61. PubMed PMID: 14517122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. AU - Wood,Evan, AU - Montaner,Julio S G, AU - Yip,Benita, AU - Tyndall,Mark W, AU - Schechter,Martin T, AU - O'Shaughnessy,Michael V, AU - Hogg,Robert S, PY - 2003/10/1/pubmed PY - 2003/10/24/medline PY - 2003/10/1/entrez SP - 656 EP - 61 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 169 IS - 7 N2 - BACKGROUND: The benefits of highly active antiretroviral therapy (HAART) for the treatment of HIV infection are well documented, but concerns regarding access and adherence to HAART are growing. We evaluated virological responses to HAART among HIV-1 infected patients who were injection drug users (IDUs) in a population-based setting where HIV/AIDS care is delivered free of charge. METHODS: We evaluated previously untreated HIV-1 infected men and women who initiated HAART between Aug. 1, 1996, and July 31, 2000, and who were followed until Mar. 31, 2002, in a province-wide HIV treatment program. We used Kaplan-Meier methods and Cox proportional hazards regression in our evaluation of time to suppression (i.e., less than 500 copies/mL) and rebound (i.e., 500 copies/mL or more) of plasma HIV-1 RNA, with patients stratified according to whether or not they had a history of injection drug use. RESULTS: Overall, 1422 patients initiated HAART during the study period, of whom 359 (25.2%) were IDUs. In Kaplan-Meier analyses, the cumulative suppression rate at 12 months after initiation of HAART was 70.8% for non-IDUs and 51.4% for IDUs (p < 0.001) (these values include people who achieved suppression before 12 months but who might not have been followed for the full 12-month period). Among patients who achieved suppression of plasma HIV-1 RNA, the cumulative rebound rate at 12 months after initial suppression was 23.8% for non-IDUs and 34.7% for IDUs (p < 0.001). However, after adjustment for adherence and other covariates, the rates of HIV-1 RNA suppression (adjusted relative hazard 0.9, 95% confidence interval [CI] 0.7-1.0) and HIV-1 RNA rebound (adjusted relative hazard 1.3, 95% CI 1.0-1.6) were similar between non-IDUs and IDUs. Differences between non-IDUs and IDUs were even less pronounced in subanalyses that considered only therapy-adherent patients (p > 0.1). INTERPRETATION: Non-IDUs and IDUs had similar rates of HIV-1 RNA suppression and rebound after the initiation of HAART, once lower levels of adherence were taken into account. Nevertheless, the lower virological response rates among IDUs suggest that, unless interventions are undertaken to improve adherence, these patients may experience elevated rates of disease progression and use of medical services in our setting. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/14517122/Adherence_and_plasma_HIV_RNA_responses_to_highly_active_antiretroviral_therapy_among_HIV_1_infected_injection_drug_users_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&amp;pmid=14517122 DB - PRIME DP - Unbound Medicine ER -