Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

Feelemyer, Jonathan; Jarlais, Don Des; Arasteh, Kamyar; Uusküla, Anneli

doi:10.1007/s10461-014-0928-3

Cited by 32 publications

(25 citation statements)

References 43 publications

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“…The majority of HCV co-infected patients in this study were PWID (69.2%), and this population usually has an unstable lifestyle, and a significant proportion (estimated 90%) of them continue to use drugs after initiating ART. 45 Low ART adherence among drug users was reported in previous studies, 46,47 which may further reduce the treatment benefits of ART and increase the treatment failure risk.…”

Section: Association Between Hepatotoxicity and Hepatitis Co-infectmentioning

confidence: 96%

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HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

Fairley

Sasadeusz

et al. 2017

Journal of Medical Virology

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Co-infection with hepatitis B (HBV) and C (HCV) is common among people living with HIV (PLHIV). This study investigates the impacts of hepatitis co-infection on antiretroviral therapy (ART) outcomes and hepatotoxicity in PLHIV. The cohort study included 1984 PLHIV. Hepatotoxicity was defined by elevated alanine aminotransferase (ALT) levels. ART outcomes were measured by CD4 cell counts, viral load, and mortality rate in patients. Among 1984 PLHIV, 184 (9.3%) were co-infected with HBV and 198 (10.0%) with HCV and 54 (2.7%) were co-infected with HBV and HCV. Of these patients, 156 (7.9%) had ALT elevation ≥ grade 1 at baseline. During the course of ART, the mortality rate and its adjusted hazard ratio (AHR) in PLHIV who were co-infected with HCV (2.6/100 person-years [py], AHR = 2.3, 95%CI 1.1-4.7) was higher than for patients with mono-infected HIV, as it was for those with an elevated ALT (4.4/100 py, AHR = 3.8, [1.7-8.2]) at baseline compared to those with normal ALT. After 6-12 months of ART, the incidence of hepatotoxicity among all the patients was 3.7/100 py. The risk of hepatotoxicity was higher in HCV co-infected (18.6/100 py, adjusted odds ratio [AOR] = 12.4, [8.1-18.2]) than HIV mono-infected patients, and for all regimens (nevirapine: 30.0/100 py, 34.2, 7.3-47.9; zidovudine/stavudine: 24.7/100 py, 22.1, 7.1-25.5; efavirenz: 14.5/100 py, 9.4, 3.5-19.2; lopinavir/ritonavir: 40.1/100 py, 52.2, 9.5-88.2) except tenofovir (4.3/100 py, 4.9, 0.8-9.5). Patients with HBV/HCV co-infected had high hepatotoxicity (10.0/100 py, 6.3, 1.2-23.3) over the same period. Patients with HCV co-infection and HBV/HCV co-infection demonstrated higher hepatotoxicity rate compared with HIV mono-infected patients in China.

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Section: Association Between Hepatotoxicity and Hepatitis Co-infectmentioning

confidence: 96%

“…A total of 1984 PLHIV initiating ART and were tested for HBV and HCV at baseline (Table 1). The median age of patients was 39 years (IQR [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49], and the median CD4+ T-cell count was 152 cells/mm 3…”

Section: Demographic Characteristics and Hepatitis Infection At Basmentioning

confidence: 99%

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

Fairley

Sasadeusz

et al. 2017

Journal of Medical Virology

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“…Moreover, many studies describe suboptimal ART adherence among PWID [40] despite wide- spread evidence that PWID are able to achieve the same levels of adherence as PLHIV who do not inject drugs [41], suggesting that both social and policy- level barriers to optimal ART adherence among this group persist. For example, research has shown that physicians often defer ART initiation for some PWID because of concerns of a so-called unstable lifestyle and competing priorities that could lead to noncompliance, and potentially the emergence and transmission of drug-resistant HIV [38].…”

Section: Hiv/aids-related Mortality In the Modern Treatment Eramentioning

confidence: 99%

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Parashar

Collins

Montaner

et al. 2016

Current Opinion in HIV and AIDS

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Purpose of review The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group. Recent findings The current leading causes of death among HIV-positive PWID are HIV/AIDS-related causes, overdose, and liver-related causes, including infection with hepatitis C virus. Elevated mortality levels in this population are driven by social–structural barriers to ART access and adherence, particularly criminalization and stigmatization of drug use. In contexts where opioid substitution therapy and ART adherence support programs are widely accessible, evidence highlights comparable levels of survival among HIV-positive PWID and people living with HIV who do not inject drugs. Summary The life-saving benefits of ART can be realized among HIV-positive PWID when it is paired with strategies that address barriers to evidence-based medical care. Joint administration of ART and opioid substitution therapy, as well as repeal of punitive laws that criminalize drug users, are urgently needed to reduce HIV and injection-related mortality among PWID.

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“…It has been demonstrated that 95% adherence is necessary to maintain viral suppression and halt disease progression (8). An international systematic review of several studies from 7 countries revealed that adherence levels were 33-97% (9). The cumulative adherence to ART was 70-89% among HIV patients who were receiving health services from Johns Hopkins AIDS Service Center (10).…”

Section: Introductionmentioning

confidence: 99%

Adherence to antiretroviral therapy in HIV-positive, male intravenous drug users in Pakistan

Ali¹,

Nisar²,

Nawab³

2018

East Mediterr Health J

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Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

Cited by 32 publications

References 43 publications

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Adherence to antiretroviral therapy in HIV-positive, male intravenous drug users in Pakistan

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