Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, United States.
British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC V6T 1Z2, Canada.
Drug Alcohol Depend. 2020 Jan 1;206:107670. doi: 10.1016/j.drugalcdep.2019.107670. Epub 2019 Oct 25.
Women living with HIV who use illicit drugs may be particularly vulnerable to HIV-1 RNA viral load (VL) rebound.
We used longitudinal data from 2006 to 2017 to evaluate the impact of sociodemographic, behavioral, social-structural, and clinical factors on the hazard of viral rebound for women enrolled in the ACCESS study, a prospective cohort with systematic VL monitoring. Women were included if they achieved VL suppression (<50 copies/mL) following antiretroviral therapy (ART) initiation and had more than one study interview. Sociodemographic as well as substance use, social-structural, addiction treatment, and HIV clinical factors were evaluated as predictors of viral rebound (VL > 1000 copies/mL). Cox regressions using a recurrent events framework, time-varying covariates, robust standard errors, and a frailty component were used.
Of the 185 women included, 62 (34%) experienced at least one viral rebound event over an 11-year period, accumulating a total of 87 viral rebound events. In adjusted analysis, stimulant use more than doubled the hazard of viral rebound (adjusted hazard ratio [AHR]: 2.35, 95% confidence interval [CI]: 1.07-5.14) while the only factor protective against viral rebound was receipt of opioid agonist treatment (OAT) in the past six months (AHR: 0.46, 95% CI: 0.26-0.81). After adjusting for ART adherence in the past six months, the effect of OAT was attenuated (AHR: 0.57, 95% CI: 0.32-1.02).
Efforts to improve access to and retention within OAT programs and decrease stimulant use may improve rates of viral suppression for HIV-positive women who use illicit drugs.
感染 HIV 的女性吸毒者可能特别容易出现 HIV-1 RNA 病毒载量（VL）反弹。
我们使用了 2006 年至 2017 年的纵向数据，评估了社会人口统计学、行为、社会结构和临床因素对 ACCESS 研究中接受抗逆转录病毒治疗（ART）的女性发生病毒反弹危险的影响，这是一个具有系统 VL 监测的前瞻性队列。如果女性在开始接受抗逆转录病毒治疗（ART）后达到 VL 抑制（<50 拷贝/ml）并且有多次研究访谈，则将其纳入研究。社会人口统计学以及物质使用、社会结构、成瘾治疗和 HIV 临床因素被评估为病毒反弹（VL>1000 拷贝/ml）的预测因子。使用复发事件框架、时变协变量、稳健标准误差和脆弱性成分的 Cox 回归进行分析。
在 185 名纳入的女性中，62 名（34%）在 11 年内至少经历了一次病毒反弹事件，总共积累了 87 次病毒反弹事件。在调整分析中，兴奋剂使用使病毒反弹的危险增加了一倍以上（调整后的危险比 [AHR]：2.35，95%置信区间 [CI]：1.07-5.14），而唯一能预防病毒反弹的因素是过去六个月内接受阿片类激动剂治疗（OAT）（AHR：0.46，95%CI：0.26-0.81）。在调整过去六个月的 ART 依从性后，OAT 的作用减弱（AHR：0.57，95%CI：0.32-1.02）。
努力增加接受 OAT 方案的机会并保留在方案内，减少兴奋剂的使用，可能会提高感染 HIV 的吸毒女性的病毒抑制率。
