Durable HIV Suppression Among People Who Inject Drugs From a Community-Based Cohort Study in Baltimore, Maryland, 1997-2017
Durable HIV Suppression Among People Who Inject Drugs From a Community-Based Cohort Study in Baltimore, Maryland, 1997-2017
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DOI：
10.1093/aje/kwz258
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发表时间：
2019-12-01
影响因子：
5
通讯作者：
Mehta, Shruti H.
中科院分区：
文献类型：
--
作者：
Genberg, Becky L.;Kirk, Gregory D.;Mehta, Shruti H.
注射毒品（PWID）的人面临人类免疫缺陷病毒（HIV）治疗结果的差异，并且可能不太可能实现持久的病毒抑制。我们在一项长期的基于社区的PWID队列研究中描述了1997年至2017年病毒抑制的过渡，即艾滋病与静脉注射经历（ALIVE）研究，分析了在1997年或之后进行研究访问的HIV阳性参与者。我们定义了在4种状态之间转换的概率：1）抑制，2）可检测，3）失访和4）死亡。我们使用多项逻辑回归分析来检查与转换概率相关的因素，重点是从抑制到其他状态的转换。在1,061名参与者中，中位年龄为44岁，32%为女性，93%为非洲裔美国人，59%最近注射过药物，28%在基线时病毒学抑制。随着时间的推移，观察到持久病毒抑制的显著改善;然而，死亡率保持相对稳定。在调整后的分析中，注射吸毒和无家可归与早期病毒学反弹增加相关，而在2012-2017年，只有年龄和种族与病毒学反弹相关。阿片类药物的使用与2012-2017年抑制后的死亡风险增加有关。尽管在持久的病毒抑制方面有了显著的改善，但PWID亚组可能需要额外的努力来维持病毒抑制和预防过早死亡。
People who inject drugs (PWID) face disparities in human immunodeficiency virus (HIV) treatment outcomes and may be less likely to achieve durable viral suppression. We characterized transitions into and out of viral suppression from 1997 to 2017 in a long-standing community-based cohort study of PWID, the AIDS Link to Intravenous Experience (ALIVE) Study, analyzing HIV-positive participants who had made a study visit in or after 1997. We defined the probabilities of transitioning between 4 states: 1) suppressed, 2) detectable, 3) lost to follow-up, and 4) deceased. We used multinomial logistic regression analysis to examine factors associated with transition probabilities, with a focus on transitions from suppression to other states. Among 1,061 participants, the median age was 44 years, 32% were female, 93% were African-American, 59% had recently injected drugs, and 28% were virologically suppressed at baseline. Significant improvements in durable viral suppression were observed over time; however, death rates remained relatively stable. In adjusted analysis, injection drug use and homelessness were associated with increased virological rebound in earlier time periods, while only age and race were associated with virological rebound in 2012-2017. Opioid use was associated with an increased risk of death following suppression in 2012-2017. Despite significant improvements in durable viral suppression, subgroups of PWID may need additional efforts to maintain viral suppression and prevent premature mortality.