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.
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Author affiliations: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Becky L. Genberg, Gregory D. Kirk, Jacquie Astemborski, Noya Galai, Kenrad E. Nelson, David D. Celentano, Shruti H. Mehta); Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Gregory D. Kirk); Food and Drug Administration, US Department of Health and Human Services, Silver Spring, Maryland (Hana Lee); and Departments of Epidemiology and Public Health, School of Nursing, Yale University, Orange, Connecticut (David Vlahov). This work was supported by the National Institutes of Health (grants U01 DA036297 and R01 DA125698) and the Johns Hopkins Center for AIDS Research (grant P30 AI094189). We thank the ALIVE Study staff and the participants who have generously donated their time over the years. The views expressed in this article are those of the authors and do not necessarily reflect the views of the National Institutes of Health or the Food and Drug Administration. Conflict of interest: none declared.
© 2019 Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2019.
- acquired immunodeficiency syndrome
- HIV care continuum
- people who inject drugs
- viral suppression
ASJC Scopus subject areas