Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: an observational cohort study.

Abstract

OBJECTIVE:

Studies have demonstrated the central function of plasma HIV-1 RNA viral load (pVL) levels on determining the risk of HIV disease progression and transmission. However, there is limited empirical research on virologic outcomes among sex workers who use illicit drugs (SW-DU).

METHODS:

Data were derived from the AIDS Care Cohort to evaluate Exposure to Survival Services, a cohort of HIV-positive illicit drug users. Using generalised estimating equations, we studied the longitudinal relationship between sex work and pVL suppression. We also tested whether adherence to antiretroviral therapy (ART) mediated the relationship between sex work and pVL suppression.

RESULTS:

Between May 1996 and May 2012, 587 ART-exposed participants (2224 person-years of observation) were included in the study, among whom 127 (21.6%) reported sex work. In a time-updated multivariate model adjusted for various demographic, socioeconomic and clinical confounders (eg, gender, incarceration, CD4 cell count), SW-DU had an independently reduced odds of pVL suppression compared to non-SW-DU (adjusted OR (AOR)=0.66; 95% CI 0.45 to 0.96). However, adding ART adherence to the multivariate model eliminated this association (p>0.05), suggesting adherence mediated the relationship between sex work and pVL suppression.

CONCLUSIONS:

Evidence-based interventions to improve adherence to ART among SW-DU are urgently needed to help produce the maximum HIV treatment and prevention benefit of ART among this highly vulnerable population.

• Authors: Lianping Ti, M-J Milloy, Kate Shannon, Annick Simo, Robert S Hogg, Sylvia Guillemi, Julio Montaner, Thomas Kerr, Evan Wood
• Journal: Sexually transmitted infections (Sex Transm Infect) Vol. 90 Issue 5 Pg. 418-22 (Aug 2014) ISSN: 1472-3263 [Electronic] England
• PMID: 24523347 (Publication Type: Journal Article, Observational Study)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Anti-HIV Agents
• Illicit Drugs
• RNA, Viral

Topics

• Adult
• Anti-HIV Agents (therapeutic use)
• CD4 Lymphocyte Count
• Canada (epidemiology)
• Cohort Studies
• Disease Progression
• Drug Users (statistics & numerical data)
• Female
• HIV Seropositivity (drug therapy, mortality, physiopathology)
• HIV-1 (genetics, isolation & purification)
• Humans
• Illicit Drugs
• Male
• Medication Adherence (statistics & numerical data)
• Middle Aged
• RNA, Viral (isolation & purification)
• Risk Factors
• Sex Workers (statistics & numerical data)
• Social Class
• Substance Abuse, Intravenous (epidemiology)
• Treatment Outcome
• Viral Load