Increases in CD4 cell count at antiretroviral therapy initiation among HIV-positive illicit drug users during a Treatment-as-Prevention initiative in Canada

UBC Faculty Research and Publications

Increases in CD4 cell count at antiretroviral therapy initiation among HIV-positive illicit drug users during a Treatment-as-Prevention initiative in Canada Tran, Mimi; Wood, Evan; Kerr, Thomas; Patterson, Sophie; Bangsberg, David R.; Dong, Huiru; Guillemi, Silvia; Montaner, Julio; Milloy, M-J

Abstract

Background—Although Treatment-as-Prevention (TasP) efforts are a new cornerstone of efforts to respond to the HIV/AIDS pandemic, their effects among people who use drugs (PWUD) have not been fully evaluated. This study characterizes temporal trends in CD4 cell count at ART initiation and rates of virologic response among HIV-positive PWUD during a TasP initiative. Methods—We used data on individuals initiating ART within a prospective cohort of PWUD linked to comprehensive clinical records. Using multivariable linear regression, we evaluated the relationship between CD4 count prior to ART initiation and year of initiation and time to HIV-1 RNA viral load < 50 copies/mL following initiation using Cox proportional hazards modeling. Results—Among 355 individuals, CD4 count at initiation rose from 130 to 330 cells/mL from 2005 to 2013. In multivariable regression, initiation year was significantly associated with higher CD4 count (β = 29.5 cells per year, 95% CI: 21.0–37.9). Initiating ART at higher CD4 counts was significantly associated with optimal viral response (Adjusted Hazard Ratio = 1.13 per 100 cells/mL increase, 95% CI: 1.05–1.22). Discussion—Increases in CD4 cell count at initiation over time was associated with superior virologic response, consistent with the aims of the TasP initiative.

Item Metadata

Title	Increases in CD4 cell count at antiretroviral therapy initiation among HIV-positive illicit drug users during a Treatment-as-Prevention initiative in Canada
Creator	Tran, Mimi; Wood, Evan; Kerr, Thomas; Patterson, Sophie; Bangsberg, David R.; Dong, Huiru; Guillemi, Silvia; Montaner, Julio; Milloy, M-J
Contributor	British Columbia Centre for Excellence in HIV/AIDS
Date Issued	2017
Description	Background—Although Treatment-as-Prevention (TasP) efforts are a new cornerstone of efforts to respond to the HIV/AIDS pandemic, their effects among people who use drugs (PWUD) have not been fully evaluated. This study characterizes temporal trends in CD4 cell count at ART initiation and rates of virologic response among HIV-positive PWUD during a TasP initiative. Methods—We used data on individuals initiating ART within a prospective cohort of PWUD linked to comprehensive clinical records. Using multivariable linear regression, we evaluated the relationship between CD4 count prior to ART initiation and year of initiation and time to HIV-1 RNA viral load < 50 copies/mL following initiation using Cox proportional hazards modeling. Results—Among 355 individuals, CD4 count at initiation rose from 130 to 330 cells/mL from 2005 to 2013. In multivariable regression, initiation year was significantly associated with higher CD4 count (β = 29.5 cells per year, 95% CI: 21.0–37.9). Initiating ART at higher CD4 counts was significantly associated with optimal viral response (Adjusted Hazard Ratio = 1.13 per 100 cells/mL increase, 95% CI: 1.05–1.22). Discussion—Increases in CD4 cell count at initiation over time was associated with superior virologic response, consistent with the aims of the TasP initiative.
Subject	HIV; antiretroviral therapy; CD4; people who use drugs; illicit drug users; Treatment-as- Prevention
Geographic Location	Downtown-Eastside (Vancouver, B.C.)
Genre	Article; Postprint
Type	Text
Language	eng
Date Available	2018-06-22
Provider	Vancouver : University of British Columbia Library
Rights	Attribution-NonCommercial-NoDerivatives 4.0 International
DOI	10.14288/1.0368706
URI	http://hdl.handle.net/2429/66343
Affiliation	Medicine, Faculty of; Other UBC; Non UBC; Medicine, Department of
Citation	Tran, M., Wood, E., Kerr, T., Patterson, S., Bangsberg, D., Dong, H., ... & Milloy, M. J. (2017). Increases in CD4 cell count at antiretroviral therapy initiation among HIV-positive illicit drug users during a Treatment-as-Prevention initiative in Canada. Antiviral therapy, 22(5), 403.
Publisher DOI	10.3851/IMP3145
Peer Review Status	Reviewed
Scholarly Level	Faculty; Researcher; Graduate
Rights URI	http://creativecommons.org/licenses/by-nc-nd/4.0/
Aggregated Source Repository	DSpace

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