Factors associated with virological suppression among HIV-positive individuals on highly active antiretroviral therapy in a multi-site Canadian cohort

Abstract

ObjectiveThe aim of the study was to evaluate time to virological suppression in a cohort of individuals who started highly active antiretroviral therapy (HAART), and to explore the factors associated with suppression. MethodsEligible participants were HIV-positive individuals from a multi-site Canadian cohort of antiretroviral-naïve patients initiating HAART on or after 1 January 2000. Viral load and CD4 measurements within 6 months prior to HAART initiation were assessed. Univariate and multivariate analyses were conducted using piecewise survival exponential models where time scale was divided into intervals (o10 months; 10 months). Virological suppression was defined as the time to the first of at least two consecutive viral load measurements o50 HIV-1 RNA copies/mL. ResultsA total of 3555 individuals were included in the study, of median age 40 years [interquartile range (IQR) 34-47 years]. Eighty per cent were male, 18% had a history of injecting drug use (IDU), and 13% presented with an AIDS-defining illness at baseline. The median time to suppression was 4.55 months . In multivariate analyses, older age, male sex, treatment in Ontario rather than British Columbia, non-IDU history, and having an AIDS diagnosis at baseline predicted increased likelihood of suppression. Patients with low baseline viral load were more likely to have suppression [4-5 log 10 copies/mL, hazard ratio (HR) 1.27, 95% confidence interval (CI) 1.18-1.38; o4 log 10 copies/mL, HR 1.49, 95% CI 1.32-1.68] than patients with baseline viral load 5 log 10 copies/mL; however, this effect ceased after 18 months of follow-up. Suppression was more likely with nonnucleoside reverse transcriptase inhibitors and ritonavir-boosted HAART. ConclusionIdentification of patients at risk for diminished likelihood of virological suppression will allow focusing of efforts and the utilization of resources to maximize the benefits of HAART.Keywords: Canada, CANOC, highly active antiretroviral therapy, HIV, virological suppression Accepted 17 August 2010Correspondence: Dr Curtis Cooper, The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, G12 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Tel: 613 737 8924; fax: 613 737 8164; e-mail: ccooper@Ottawahospital.on.ca DOI: 10.1111/j.1468-1293.00890.x HIV Medicine (2011 r 2010 British HIV Association 352 IntroductionIt is well documented that highly active antiretroviral therapy (HAART) decreases morbidity and mortality amongst HIV-positive individuals [1][2][3][4]. In particular, one of the primary goals of HAART is the obtainment and maintenance of complete HIV RNA suppression [5]. Failure to achieve and maintain suppression can result in the development of drug resistance and also increases the risk of both horizontal and vertical viral transmission [6][7][8].When first initiating antiretroviral therapy, the obtainment of viral load suppression is an important objective that is associated with a variety of socio-demographic and baseline clinical factors [9,10]. Additionally, choice of initial...

Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis

“…Previous Canadian studies have shown that women experience poorer HIV-related clinical outcomes compared with men, mediated by suboptimal engagement and retention within HIV services and lower adherence to antiretroviral therapy. [18][19][20][21]25,26 Inconsistent condom use among women living with HIV is well-described in the literature, attributed to fertility desire and serocondordant partnerships, in addition to challenges negotiating condom use, including gendered power imbalances, fear of inadvertent status disclosure and the threat of violence. [27][28][29][30] Marginalized women living with HIV may experience additional social-structural barriers to insisting upon safer sex practices, particularly those who are economically disadvantaged and who engage in survival sex work, 8,31,32 compromising their ability to avoid criminal liability for HIV nondisclosure through both achievement of a low viral load and condom use.…”

Low-Frequency Drug Resistance in HIV-Infected Ugandans on Antiretroviral Treatment Is Associated with Regimen Failure

“…Initiating cART earlier in disease is obviously beneficial to patient outcome, but only if the patient remains adherent to the cART with full viral suppression (61). Full viral suppression on first-line cART is achieved in Ͼ85% of treatmentnaive HIV-infected individuals/year in HICs (62)(63)(64), but in LMICs, these rates are less than 80% per year (64)(65)(66). Antiretroviral treatment failure is largely due to poor adherence in subSaharan Africa, but purely behavior-based decisions to stop medications are rare, and with access to medication, adherence rates are similar to those in HICs (64,66).…”

The use of funnel plots with regression as a tool to visually compare HIV treatment outcomes between centres adjusting for patient characteristics and size: a UK Collaborative HIV Cohort study

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