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Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting : an observational cohort study Ti, Lianping; Milloy, M-J; Shannon, K.; Simo, Annick; Hogg, Robert S.; Guillemi, Sylvia; Montaner, Julio; Kerr, Thomas; Wood, Evan

Abstract

Objective—Studies have demonstrated the central function of plasma HIV-1 RNA viral load (pVL) levels on determining the risk of HIV disease progression and transmission. However, there is limited empirical research on virologic outcomes among sex workers who use illicit drugs (SWDU). Methods—Data were derived from the AIDS Care Cohort to evaluate Exposure to Survival Services, a cohort of HIV-positive illicit drug users. Using generalised estimating equations, we studied the longitudinal relationship between sex work and pVL suppression. We also tested whether adherence to antiretroviral therapy (ART) mediated the relationship between sex work and pVL suppression. Results—Between May 1996 and May 2012, 587 ART-exposed participants (2224 person-years of observation) were included in the study, among whom 127 (21.6%) reported sex work. In a time-updated multivariate model adjusted for various demographic, socioeconomic and clinical confounders (eg, gender, incarceration, CD4 cell count), SW-DU had an independently reduced odds of pVL suppression compared to non-SW-DU (adjusted OR (AOR)=0.66; 95% CI 0.45 to 0.96). However, adding ART adherence to the multivariate model eliminated this association (p>0.05), suggesting adherence mediated the relationship between sex work and pVL suppression. Conclusions—Evidence-based interventions to improve adherence to ART among SW-DU are urgently needed to help produce the maximum HIV treatment and prevention benefit of ART among this highly vulnerable population.

Item Metadata

Title
Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting : an observational cohort study
Creator
Ti, Lianping; Milloy, M-J; Shannon, K.; Simo, Annick; Hogg, Robert S.; Guillemi, Sylvia; Montaner, Julio; Kerr, Thomas; Wood, Evan
Contributor
British Columbia Centre for Excellence in HIV/AIDS
Date Issued
2014-02-12
Description
Objective—Studies have demonstrated the central function of plasma HIV-1 RNA viral load (pVL) levels on determining the risk of HIV disease progression and transmission. However, there is limited empirical research on virologic outcomes among sex workers who use illicit drugs (SWDU). Methods—Data were derived from the AIDS Care Cohort to evaluate Exposure to Survival Services, a cohort of HIV-positive illicit drug users. Using generalised estimating equations, we studied the longitudinal relationship between sex work and pVL suppression. We also tested whether adherence to antiretroviral therapy (ART) mediated the relationship between sex work and pVL suppression. Results—Between May 1996 and May 2012, 587 ART-exposed participants (2224 person-years of observation) were included in the study, among whom 127 (21.6%) reported sex work. In a time-updated multivariate model adjusted for various demographic, socioeconomic and clinical confounders (eg, gender, incarceration, CD4 cell count), SW-DU had an independently reduced odds of pVL suppression compared to non-SW-DU (adjusted OR (AOR)=0.66; 95% CI 0.45 to 0.96). However, adding ART adherence to the multivariate model eliminated this association (p>0.05), suggesting adherence mediated the relationship between sex work and pVL suppression. Conclusions—Evidence-based interventions to improve adherence to ART among SW-DU are urgently needed to help produce the maximum HIV treatment and prevention benefit of ART among this highly vulnerable population.
Subject
Downtown-Eastside (Vancouver, B.C.)
Geographic Location
Downtown-Eastside (Vancouver, B.C.)
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2018-08-03
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0369293
URI
http://hdl.handle.net/2429/66664
Affiliation
Medicine, Faculty of; Other UBC; Non UBC; Family Practice, Department of; Medicine, Department of; Population and Public Health (SPPH), School of
Citation
Ti, L., Milloy, M.-J., Shannon, K., Simo, A., Hogg, R. S., Guillemi, S., … Wood, E. (2014).Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: an observational cohort study, 90(5), 418–422.
Publisher DOI
10.1136/sextrans-2013-051408
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher; Graduate
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International