Loeb Talia A, Solomon Sunil S, Gunaratne Mihili P, Srikrishnan A K, Vasudevan C K, Khan Rifa T, Anand Santhanam, Jayaseelan Boobalan, Kumar Muniratnam Suresh, Celentano David D, Lucas Gregory M, Mehta Shruti H, McFall Allison M
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
AIDS Care. 2025 Jul;37(7):1085-1096. doi: 10.1080/09540121.2025.2484635. Epub 2025 Mar 28.
People who inject drugs (PWID) and men who have sex with men (MSM) in India are disproportionately affected by HIV and experience challenges achieving sustained viral suppression. We evaluated probabilities of suppression over time and characteristics associated with persistent viremia and viral rebound among MSM and PWID living with HIV (PLHIV) using 12 months of data collected between 2017-2019 from a cluster-randomized trial across 16 cities in India. To assessprobabilities of suppression, we fit logistic transition models with generalized estimating equations. To assess correlates of persistent viremia and viral rebound, we fit multivariable multilevel logistic regression models. Of 750 PWID, 88% were male and 14% completed high school. Of 850 MSM, 29% completed high school and 54% were married. 46% of PWID and 67% of MSM maintained viral suppression once achieved. Probabilities of viral rebound decreased over time. The probability of newly achieving suppression decreased, from 33%-12% after six months among PWID and 60%-13% among MSM. Among PWID, correlates of persistent viremia included lower education, employment, homelessness, and active injection. Among MSM, hazardous alcohol use was associated with viremia and viral rebound. Treatment engagement and support efforts need to be intensified to encourage PLHIV to achieve life-long suppression.
在印度，注射毒品者（PWID）和男男性行为者（MSM）受艾滋病毒影响的比例过高，并且在实现持续病毒抑制方面面临挑战。我们利用2017年至2019年期间从印度16个城市的一项整群随机试验中收集的12个月数据，评估了艾滋病毒感染者（PLHIV）中男男性行为者和注射毒品者随着时间推移实现病毒抑制的概率，以及与持续病毒血症和病毒反弹相关的特征。为了评估病毒抑制的概率，我们使用广义估计方程拟合逻辑转换模型。为了评估持续病毒血症和病毒反弹的相关因素，我们拟合了多变量多水平逻辑回归模型。在750名注射毒品者中，88%为男性，14%完成了高中学业。在850名男男性行为者中，29%完成了高中学业，54%已婚。46%的注射毒品者和67%的男男性行为者一旦实现病毒抑制就能维持下去。病毒反弹的概率随时间下降。新实现病毒抑制的概率下降，注射毒品者在6个月后从33%降至12%，男男性行为者从60%降至13%。在注射毒品者中，持续病毒血症的相关因素包括教育程度较低、就业、无家可归和仍在注射毒品。在男男性行为者中，危险饮酒与病毒血症和病毒反弹有关。需要加强治疗参与和支持力度，以鼓励艾滋病毒感染者实现终身病毒抑制。
