Mortality and virological failure among HIV-infected people who inject drugs on antiretroviral treatment in China: An observational cohort study

Zhao, Yan; Zhang, Mingjie; Shi, Cynthia X.; Huang, Jie; Zhang, Fujie; Rou, Keming; Wu, Zunyou

doi:10.1016/j.drugalcdep.2016.11.011

Cited by 12 publications

(13 citation statements)

References 41 publications

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“…It is possible that PWID receiving and not receiving MMT may have different characteristics, and that the effect of MMT on adherence may be mitigated over time [19]. Another study in China found that those engaged in MMT had substantially lower mortality rate than those who actively use drugs, while virological failure rate were similar between the two groups [29]. In our study, anecdotal information suggested that there is an increasing use of amphetamine-like stimulants among people who inject heroin and MMT users, which might have had impact on the adherence and viral suppression.…”

Section: Discussionmentioning

confidence: 99%

A prospective “test‐and‐treat” demonstration project among people who inject drugs in Vietnam

et al. 2018

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IntroductionModelling suggests that early diagnosis and immediate antiretroviral therapy (ART) among key populations would have a substantial impact in reducing HIV transmission and mortality in Vietnam. An implementation research project of “test‐and‐treat” among people who inject drugs (PWID) was developed to inform effective roll‐out of such interventions.Methods“Test‐and‐treat” was offered to PWID in two high burden provinces, Thai Nguyen and Thanh Hoa. The interventions comprised the offer of biannual HIV testing and immediate ART, irrespective of CD4 count. PWID were enrolled between April 2014 and July 2015 and followed up for 12 months, and retention, HIV viral load (VL) and risk behaviours were assessed. Retention in care of this prospective cohort was compared with the retention among men enrolled in care in the preceding period (April 2012 to March 2013) at the same clinics when ART was initiated at CD4 cell count ≤350 cells/mm3.ResultsIn total, 287 HIV positive PWID started immediate ART. The majority (98%) were men; median age was 34; and median (interquartile range) CD4 count was 199 (50 to 402) cells/mm3. After 12 months, 238 participants (83%) were retained on ART, and 205 achieved viral suppression (<1000 copies/mL) (92% among those in whom VL was measured, 71% overall). Baseline CD4 count ≤100 cells/mm3 and history of imprisonment were associated with lower retention and viral suppression, while engagement in methadone maintenance was associated with higher retention. Retention in care was higher in the “test‐and‐treat” cohort (83%) compared with men enrolled in care in the preceding period (78%), primarily because lost‐to‐follow‐up during pre‐ART care was eliminated. No decline in consistent condom use and clean needle use was observed.ConclusionsEarly ART initiation resulted in successful treatment outcomes among PWID, with no observed increase in self‐reported risk behaviours, suggesting feasibility and potential effectiveness of “test‐and‐treat” approach. The results also call for differentiated care for PWID, including promoting early diagnosis and engagement in methadone maintenance therapy while enhancing care for those with advanced HIV disease and history of imprisonment.

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Section: Discussionmentioning

confidence: 99%

A prospective “test‐and‐treat” demonstration project among people who inject drugs in Vietnam

et al. 2018

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“…This study reports that HIV drug-experienced individuals in formal or informal employment were protected from VF. Unemployment among HIV-infected individuals was previously described as a stressful event which reduced adherence to prescribed HIV medications resulting in high rates of VF [ 35 ] and increased mortality [ 36 ]. Supporting and engaging PLHIV in income-generating activities may stabilize financial and social status and positively impact drug adherence and favourable treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Out of the 124, 63 (50.8%) participants had VF and 61 (49.2%) had VS. The age of the 124 participants ranged from 15 to 79 years, with a median [IQR] age of 45 [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] years. Of the 124; 82 (66.1%) were females and 89 (71.8%) were employed in either formal or informal sector.…”

Section: Demographic Characteristics Of Study Participantsmentioning

confidence: 99%

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Patterns of acquired HIV-1 drug resistance mutations and predictors of virological failure in Moshi, Northern Tanzania

et al. 2020

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Emergence of HIV drug resistance poses a serious risk of inactivity to all currently approved antiretroviral drugs. Profiles of HIV drug resistance mutations (HIVDRM) and virological failure (VF) are not extensively studied in Tanzania. This study aimed to determine HIVDRM and predictors of VF in HIV-infected individuals failing first-line HIV drugs in Moshi, Northern Tanzania. A case-control study was conducted at Kilimanjaro Christian Medical Centre, Mawenzi, Pasua and Majengo health facilities with HIV-care and treatment clinics from October, 2017 to August, 2018. Cases and controls were HIV-infected individuals with VF and viral suppression (VS) respectively. HIV-1 reverse transcriptase and protease genes were amplified and sequenced. Stanford University’s HIV drug resistance database and REGA subtyping tool 3.0 determined HIVDRM and HIV-1 subtypes respectively. Odds ratios (OR) with 95% confidence interval (95% CI) investigated predictors of VF. P -value < 5% was considered statistically significant. A total of 124 participants were recruited, of whom 63 (50.8%) had VF, 61 (49.2%) had VS and 82 (66.1%) were females. Median [IQR] age and duration on ART were 45 [35–52] years and 72 [48–104] months respectively. Twenty-five out of 26 selected samples from cases were successfully sequenced. Twenty-four samples (96%) had at least one major mutation conferring resistance to HIV drugs, with non-nucleoside analogue reverse transcriptase inhibitor (NNRTI)-resistance associated mutations as the majority (92%). Frequent NNRTI-resistance associated mutations were K103N (n = 11), V106M (n = 5) and G190A (n = 5). Prevalent nucleoside analogue reverse transcriptase inhibitors-resistance associated mutations were M184V (n = 17), K70R (n = 7) and D67N (n = 6). Dual-class resistance was observed in 16 (64%) samples. Thirteen samples (52%) had at least one thymidine analogue-resistance associated mutation (TAM). Three samples (12%) had T69D mutation with at least 1 TAM. Two samples (8%) had at least one mutation associated with protease inhibitor resistance. Age [aOR = 0.94, 95% CI (0.90–0.97), p < 0.001] and occupation [aOR = 0.35, 95% CI (0.12–1.04), p = 0.059] associated with VF. In conclusion, HIV drug resistance is common among people failing antiretroviral therapy. Resistance testing will help to guide switching of HIV drugs.

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“…Studies show that males less frequently visit health care providers for health concerns and in HIV-infected patients this results in prolonged elevated viral load levels before intervention and episodes of ART interruption in those already receiving treatment. One recent study highlighted this devastating association and found that HIV-infected individuals who were active IVDUs experience higher mortality rates due to poor viral management and ART interruption [77]. Nevertheless, the analysis of the Cardiovascular Diseases in HIV-infected Subjects (HIV-HEART) study by Reinsch et al [39], the multivariate analysis of an HIV-infected cohort in Spain by Quezada et al [13] and the study by Schwarze-Zander et al [73] report greater predominance of HIV-infected females with PAH.…”

Section: Epidemiology Of Pah In Hiv-infected and Intravenous Drug Usersmentioning

confidence: 99%

Drug abuse and HIV-related pulmonary hypertension

Harter

Agarwal

Dalvi

et al. 2018

Aids

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Improved survival among HIV-1 infected individuals with the advent of antiretroviral therapy has clearly led to a greater prevalence of non-infectious complications. One of the most devastating sequelae in these individuals is the development of pulmonary arterial hypertension (PAH). Various epidemiological studies suggest a worse survival of HIV-PAH patients when compared to other forms of PAH. Given that only a subset and not all HIV-infected individuals develop HIV-PAH, suggests that an additional second hit of genetic or environmental triggers is needed for the development of PAH. In this context, it has been well documented that HIV patients who abuse illicit drugs such as stimulants, opioids etc. are more susceptible to develop PAH. In this review, we highlight the studies that support the significance of a double hit of HIV and drug abuse in the incidence of PAH and focus on the research that has been undertaken to unravel the pathobiology and vascular remodeling mechanisms underlying the deleterious synergy between HIV infection and drugs of abuse in orchestrating the development of PAH.

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Mortality and virological failure among HIV-infected people who inject drugs on antiretroviral treatment in China: An observational cohort study

Cited by 12 publications

References 41 publications

A prospective “test‐and‐treat” demonstration project among people who inject drugs in Vietnam

A prospective “test‐and‐treat” demonstration project among people who inject drugs in Vietnam

Patterns of acquired HIV-1 drug resistance mutations and predictors of virological failure in Moshi, Northern Tanzania

Drug abuse and HIV-related pulmonary hypertension

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