2010
DOI: 10.1111/j.1468-1293.2010.00890.x
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Factors associated with virological suppression among HIV-positive individuals on highly active antiretroviral therapy in a multi-site Canadian cohort

Abstract: ObjectiveThe aim of the study was to evaluate time to virological suppression in a cohort of individuals who started highly active antiretroviral therapy (HAART), and to explore the factors associated with suppression. MethodsEligible participants were HIV-positive individuals from a multi-site Canadian cohort of antiretroviral-naïve patients initiating HAART on or after 1 January 2000. Viral load and CD4 measurements within 6 months prior to HAART initiation were assessed. Univariate and multivariate analyses… Show more

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Cited by 56 publications
(61 citation statements)
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“…Previous Canadian studies have shown that women experience poorer HIV-related clinical outcomes compared with men, mediated by suboptimal engagement and retention within HIV services and lower adherence to antiretroviral therapy. [18][19][20][21]25,26 Inconsistent condom use among women living with HIV is well-described in the literature, attributed to fertility desire and serocondordant partnerships, in addition to challenges negotiating condom use, including gendered power imbalances, fear of inadvertent status disclosure and the threat of violence. [27][28][29][30] Marginalized women living with HIV may experience additional social-structural barriers to insisting upon safer sex practices, particularly those who are economically disadvantaged and who engage in survival sex work, 8,31,32 compromising their ability to avoid criminal liability for HIV nondisclosure through both achievement of a low viral load and condom use.…”
Section: Discussionmentioning
confidence: 99%
“…Previous Canadian studies have shown that women experience poorer HIV-related clinical outcomes compared with men, mediated by suboptimal engagement and retention within HIV services and lower adherence to antiretroviral therapy. [18][19][20][21]25,26 Inconsistent condom use among women living with HIV is well-described in the literature, attributed to fertility desire and serocondordant partnerships, in addition to challenges negotiating condom use, including gendered power imbalances, fear of inadvertent status disclosure and the threat of violence. [27][28][29][30] Marginalized women living with HIV may experience additional social-structural barriers to insisting upon safer sex practices, particularly those who are economically disadvantaged and who engage in survival sex work, 8,31,32 compromising their ability to avoid criminal liability for HIV nondisclosure through both achievement of a low viral load and condom use.…”
Section: Discussionmentioning
confidence: 99%
“…Initiating cART earlier in disease is obviously beneficial to patient outcome, but only if the patient remains adherent to the cART with full viral suppression (61). Full viral suppression on first-line cART is achieved in Ͼ85% of treatmentnaive HIV-infected individuals/year in HICs (62)(63)(64), but in LMICs, these rates are less than 80% per year (64)(65)(66). Antiretroviral treatment failure is largely due to poor adherence in subSaharan Africa, but purely behavior-based decisions to stop medications are rare, and with access to medication, adherence rates are similar to those in HICs (64,66).…”
Section: Discussionmentioning
confidence: 99%
“…The proportion of people achieving an undetectable VL is an important indicator of programme performance as it is a marker of treatment adherence/success and has important implications for reducing onward HIV transmission 6 and for individual outcomes 7, 8. However, patient‐ as well as provider‐level factors are strongly associated with the achievement of an undetectable VL, including mode of HIV acquisition, age, gender and ethnicity 9, 10. As the characteristics of those attending different centres (the ‘case mix’) will vary, we need a tool that permits researchers to illustrate and compare performance measures, such as the proportion of people with an undetectable VL, after adjusting for any case‐mix differences.…”
Section: Introductionmentioning
confidence: 99%