We found that women and people who inject drugs are at increased risk of being suboptimally adherent to HAART. Optimal adherence remains a significant public health and clinical goal in the context of rapidly expanding access to HAART.
Housing is a known determinant of health behaviors, which includes adherence to Antiretroviral Therapy (ART). Within the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, unstable housing is inversely associated with adherence. Several comprehensive adherence support services have emerged to improve adherence for unstably housed or otherwise vulnerable populations. The Maximally Assisted Therapy (MAT) program in Vancouver, British Columbia uses a multidisciplinary approach to support HIV-positive clients with a history of addictions or mental illness, many of whom also experience episodic homelessness. This study investigated the association between antiretroviral adherence and use of support services, including the MAT program, amongst people living with HIV and AIDS who are unstably housed in the LISA sample. Of the 212 unstably housed participants, those who attended the MAT program were 4.76 times more likely to be ≥95% adherent (95% CI 1.72–13.13; P = 0.003) than those who did not. The findings suggest that in the absence of sustainable housing solutions, programs such as MAT play an important role in supporting treatment adherence in this population.
BackgroundRecent studies have suggested that failing nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens may have greater potential to induce the development of resistance mutations, which may limit options for second-line therapy.
MethodsAntiretroviral therapy (ART)-naïve individuals aged 18 years who initiated triple combination ART between January 2000 and June 2006 in British Columbia, Canada were enrolled in the study. We compared genotypic sensitivity scores (GSSs) derived from the development of resistance mutations between participants who initiated ART with ritonavir-boosted protease inhibitors (PIs) with those who initiated ART with NNRTIs, and determined the effects of these mutations on remaining active drugs.
ResultsA total of 1666 participants initiated ART, 818 (49.1%) with NNRTI-based regimens and 848 (50.9%) with boosted PI-based regimens. Among participants who developed resistance mutations, those who initiated NNRTI-based regimens had a lower median GSS than those on boosted PI-based regimens (9.8 vs. 11.0, respectively; Po0.001). Participants on boosted PI-based regimens [adjusted odds ratio (AOR) 3.68; 95% confidence interval (CI) 2.25, 6.01], those with 95% adherence to highly active antiretroviral therapy (HAART) (AOR 1.84; 95% CI 1.16, 2.92) and those with baseline CD4 count 4200 cells/mL (AOR 3.44; 95% CI 1.73, 6.84) were more likely to have the maximum number of drug options.
ConclusionThe use of NNRTI-based first-line ART regimens may limit the options for second-line treatment when the number of available drugs is limited. , before they are diagnosed with treatment failure and switched to a second-line therapy. Most patients who fail NNRTI-based therapy can be expected to have NNRTI cross-resistance and many will have some degree of NRTI resistance by the time they are switched to a second-line regimen [2,7]. It is hoped that these mutations will not affect the probability of treatment success on second-line regimens as they are based on a PI coupled with two novel NRTIs to which the patient has not been previously exposed [1]. A number of studies have provided data consistent with this expectation [8][9][10]. However, the development of thymidine analogue mutations (TAMs) or other major NRTI mutations has the potential to render these second-line regimens ineffective because of the widespread cross-resistance with other NRTIs [11]. Recent studies have suggested that failing NNRTI-based regimens have a greater susceptibility to the development of NRTI resistance mutations than do boosted PI-based regimens [12,13]. In industrialized countries, the increased frequency of these mutations is likely to be of little clinical consequence as regimens can be tailored to the individual resistance mutation profiles. However, whether these mutations would reduce effectiveness of the commonly available second-line regimens in RLSs is unknown. The aim of this study was to examine how the development of specific drug resistance mutations among individuals on highly active antiretro...
Stable serodiscordant relationships and sexual concurrency are pathways that contribute to the HIV epidemic in sub-Saharan Africa. However whether polygyny imparts the same risks as informal concurrent relationships remains an open research question. Using data collected at enrollment from a cohort study of sero-discordant couples, this analysis investigates how polygynous relationships differ from those involving only a single female spouse and whether men involved in polygynous partnerships are more likely to report HIV-risk behaviour than those in single spouse partnerships. Of 444 enrolled couples, 111 (25%) were polygynous and 333 (75%) were single-spouse partnerships. We found that polygynous men were more likely to report controlling sexual decision-making and to report any unprotected sex with unknown sero-status partner. After controlling for potential confounders, polygynous men were still more likely to report unprotected sex with an unknown sero-status partner. In this sample of sero-discordant couples we found indication of excess HIV-risk behaviour among men involved in polygynous relationships.
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