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Durable HIV Suppression Among People Who Inject Drugs From a Community-Based Cohort Study in Baltimore, Maryland,
Becky L Genberg1, Gregory D Kirk1,2, Jacquie Astemborski1
1Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
American Journal of Epidemiology
|November 20, 2019
Summary
People who inject drugs (PWID) show improved viral suppression over time, but subgroups still need targeted interventions. Continued efforts are crucial to prevent premature mortality and maintain durable viral suppression in this population.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- HIV/AIDS Research
Background:
- People who inject drugs (PWID) experience significant disparities in human immunodeficiency virus (HIV) treatment outcomes.
- Achieving and maintaining durable viral suppression remains a challenge for PWID, impacting long-term health.
- Understanding transitions between viral suppression states is critical for improving care.
Purpose of the Study:
- To characterize the dynamics of viral suppression and its transitions among HIV-positive PWID.
- To identify factors associated with transitions into and out of viral suppression over a 20-year period.
- To inform targeted interventions for improving HIV treatment outcomes in PWID.
Main Methods:
- Analysis of a long-standing community-based cohort study (AIDS Link to Intravenous Experience - ALIVE Study) from 1997 to 2017.
- Inclusion of 1,061 HIV-positive participants with study visits from 1997 onwards.
- Use of multinomial logistic regression to model transitions between viral suppression states (suppressed, detectable, lost to follow-up, deceased).
Main Results:
- Significant improvements in durable viral suppression were observed over the study period (1997-2017).
- Death rates remained relatively stable, with opioid use associated with increased mortality risk post-suppression in later years (2012-2017).
- Factors associated with virological rebound shifted over time, with injection drug use and homelessness prominent earlier, and age and race more significant later.
Conclusions:
- While overall viral suppression has improved among PWID, specific subgroups require enhanced support.
- Interventions must address factors like age, race, ongoing injection drug use, homelessness, and opioid use to maintain viral suppression and prevent mortality.
- Continued research and tailored public health strategies are essential for equitable HIV treatment outcomes in PWID.
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