Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: The role of methadone maintenance therapy

Palepu, Anita; Tyndall, Mark W.; Joy, Ruth; Kerr, Thomas; Wood, Evan; Press, Natasha; Hogg, Robert S.; Montaner, Julio S. G.

doi:10.1016/j.drugalcdep.2006.02.003

Cited by 192 publications

(166 citation statements)

References 45 publications

Supporting

Mentioning

156

Contrasting

Order By: Relevance

“…We confirm the findings of earlier studies which emphasize that successful ART is possible among former or current IDUs, and particularly effective in the setting of stable opiate substitution [5,11,18,31,32,[46][47][48]. As a consequence, ART should not be withheld from this patient group.…”

Section: Discussionsupporting

confidence: 89%

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

et al. 2009

View full text Add to dashboard Cite

ObjectivesThe aim of the study was to investigate the influence of continued injecting drug use, enrolment in an opiate substitution treatment programme (OSTP), or cessation of injecting drug use on the uptake and course of antiretroviral therapy (ART). DesignA prospective observational study of all participants in the Swiss HIV Cohort Study followed between 1997 and 2006 was carried out. MethodsWe distinguished four groups of former or current injecting drug users (IDUs): (i) abstinent former IDUs; (ii) persons in OSTPs without concomitant injecting drug use; (iii) persons in OSTPs with concomitant injecting drug use; (vi) current IDUs. These groups were compared with a group of patients who had never been IDUs. Factors related to ART uptake and virological endpoints were analysed using logistic generalized estimating equations. ResultsWe followed 8660 participants for 48 477 person-years; 29.7% were in the IDU HIV transmission group. The likelihood of being on ART at biannual visits was lower among individuals in OSTPs with concomitant injecting drug use [odds ratio (OR) 0.79; 95% confidence interval (CI) 0.71-0.89] and current IDUs (OR 0.80; 95% CI 0.67-0.96), compared with those who had never been IDUs (reference), abstinent former IDUs (OR 1.13; 95% CI 1.02-1.25) and individuals in OSTPs without injecting drug use (OR 1.18; 95% CI 1.06-1.31). The likelihood of suppressed viral replication on ART was similar among those who had never been IDUs, abstinent former IDUs and individuals in an OSTP without injecting drug use, and lower among those in OSTPs with concomitant drug use (OR 0.82; 95% CI 0.72-0.93) and current IDUs (OR 0.81; 0.65-1.00). Adherence to ART was decreased among persons with continued injecting drug use, and correlated with virological outcome. [4][5][6][7], the potential for interactions among medication, opiate substitution and illicit drugs [8], adverse effects [9], and limited access to [10,11], delayed use of [10,12,13], and decreased response to treatment [4,7]. As a consequence of such difficulties, physicians may be reluctant to offer ART to HIV-infected IDUs [14,15], resulting in less than optimal care and worse outcome [16,17].In HIV research, the term 'IDU' is commonly used to describe the HIV transmission category or patient characteristics. When investigating the course of HIV infection and the outcome of ART in these patients, however, it is an oversimplification to consider IDUs as a homogenous group. IDUs frequently change their drug injection behaviour, drug addiction treatment status or health care setting [18,19]. We aimed to investigate the influence of injecting drug use behaviour and enrolment in opiate substitution treatment programmes on the uptake of and virological response to ART among persons classified as belonging to the IDU HIV transmission group, and to study the association between injecting drug use behaviour and adherence to ART. We distinguished four distinct groups of former or current IDUs: (i) abstinent former IDUs who had completely stopped injecting d...

show abstract

Section: Discussionsupporting

confidence: 89%

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

et al. 2009

View full text Add to dashboard Cite

show abstract

“…13,21 Consistent with previous analyses, this ratio was dichotomized to 95% or more versus less than 95%. 19,[22][23][24] In British Columbia, all provision of ART is centralized through a province-wide antiretroviral dispensation program. Confidential linkage of records from this program to the ACCESS database allowed for accurate determination of adherence.…”

Section: Outcome Variablesmentioning

confidence: 99%

“…19,20 ACCESS was originally nested within the larger Vancouver Injection Drug User Study (VIDUS). Briefly, VIDUS participants have been recruited since May 1996 through self-referral and street-based outreach from Vancouver's Downtown Eastside neighborhood.…”

Section: Study Samplementioning

confidence: 99%

Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users

Hadland

Milloy

Kerr

et al. 2012

AIDS Patient Care and STDs

Self Cite

View full text Add to dashboard Cite

Previous studies of adherence to antiretroviral therapy (ART) for HIV among young injection drug users (IDU) have been limited because financial barriers to care disproportionately affect youth, thus confounding results. This study examines adherence among IDU in a unique setting where all medical care is provided free-of-charge. From May 1996 to April 2008, we followed a prospective cohort of 545 HIV-positive IDU of 18 years of age or older in Vancouver, Canada. Using generalized estimating equations (GEE), we studied the association between age and adherence (obtaining ART ‡ 95% of the prescribed time), controlling for potential confounders. Using Cox proportional hazards regression, we also studied the effect of age on time to viral load suppression ( < 500 copies per milliliter), and examined adherence as a mediating variable. Five hundred forty-five participants were followed for a median of 23.

show abstract

“…This is of particular concern given that morbidity can be worse, disease progression -16-more rapid, and treatment more difficult for HIV co-infected individuals (PHAC, 2007) Hogg et al (1998), Ory andMack (1998), andPalella et al (1998) found that the introduction of highly active antiretroviral therapy (HAART) has substantially reduced HIV/AIDS associated morbidity and mortality (as cited in Hinkin et al, 2007). Palepu et al (2006) reports methadone maintenance therapy (MMT) played a significant role in providing improved health outcomes for this susceptible population. Among HIV/HCV co-infected IDUs on HAART, enrolment in MMT was related with reduced heroin use, and enhanced adherence, HIV-1 RNA (the viral load) suppression and CD4 cell count rise.…”

Section: Co-infectionmentioning

confidence: 99%

“…This success is not shared equally among HIV infected populations. IDUs and other marginalized groups consistently exhibit reduced HAART uptake, lower treatment adherence, greater virologic failure, and in turn, faster progression of their HIV illness (Palepu et al, 2006). Socio-economical and psychological factors contribute to these trends seen in vulnerable populations (Palepu et al, 2006).…”

Section: Co-infectionmentioning

confidence: 99%

"People need to listen to us": Empowering people living with HIV/AIDS through positive prevention.

Slotwinski¹

View full text Add to dashboard Cite

Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: The role of methadone maintenance therapy

Cited by 192 publications

References 45 publications

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users

"People need to listen to us": Empowering people living with HIV/AIDS through positive prevention.

Contact Info

Product

Resources

About