Substance use patterns and HIV-1 RNA viral load rebound among HIV-positive illicit drug users in a Canadian setting.

2018 | Antivir Ther

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 viral load (VL) following antiretroviral therapy (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 analyzed time to VL rebound (i.e., two consecutive observations ≥ 1000 copies/mL) after ART initiation and sustained viral suppression (i.e., two consecutive observations < 50 c/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 viral load suppression and contributed 1893.8 person-years of observation. Over follow-up, 198 (35.1%) participants experienced ≥ 1 instance of VL rebound. In adjusted analyses, VL rebound was associated with younger age (Adjusted Hazard Ratio = 0.97, 95% Confidence Interval: 0.95, 0.98), heroin injection (≥ daily vs. < daily, AHR = 1.52, 95% CI: 1.01, 2.30), crack use (≥ daily vs. < daily, AHR = 1.73, 95% 1.08, 1.92) and heavy alcohol use (≥ 4 vs. < 4 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 healthcare 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 virologic control and maintain the benefits of ART.

BC Centre for Excellence in HIV/AIDS

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Substance use patterns and HIV-1 RNA viral load rebound among HIV-positive illicit drug users in a Canadian setting.

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