Receipt of opioid agonist treatment halves the risk of HIV-1 RNA viral load rebound through improved ART adherence for HIV-infected women who use illicit drugs

• Published in: Drug and alcohol dependence Vol. 206; p. 107670
• Main Authors: Adams, Joëlla W., Marshall, Brandon D.L., Mohd Salleh, Nur Afiqah, Barrios, Rolando, Nolan, Seonaid, Milloy, M.-J.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2020; Elsevier Science Ltd
• Subjects: Addictions; Adult; Agonists; Analgesics, Opioid - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active - psychology; Cohort Studies; Confidence intervals; Drug abuse; Drugs; Female; Health risks; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - psychology; HIV-1; HIV-1 - genetics; Human immunodeficiency virus; Humans; Illicit drugs; Illicit Drugs - adverse effects; Male; Medical treatment; Medication Adherence - psychology; Medication assisted treatment of opioid use disorder; Middle Aged; Narcotics; Opioid-related disorders; Opioids; Patient compliance; Prospective Studies; Protective Agents - therapeutic use; Recurrent; Recurrent events; Regression analysis; Ribonucleic acid; RNA; Robustness (mathematics); Sociodemographics; Substance abuse; Substance use; Substance-Related Disorders - complications; Substance-Related Disorders - drug therapy; Viral Load - drug effects; Women; Women; HIV-1; Medication assisted treatment of opioid use disorder; Illicit drugs; Opioid-related disorders
• DOI: 10.1016/j.drugalcdep.2019.107670
• ISSN: 0376-8716; 1879-0046

•Most studies aren’t powered to examine risk factors for HIV viral rebound specifically for women.•Longitudinal analyses for a cohort of women living with HIV who use illicit drugs.•Opioid agonist treatment in the past six months halved the hazard of viral rebound.•Recent stimulant use more than doubled hazard of viral rebound. Women living with HIV who use illicit drugs may be particularly vulnerable to HIV-1 RNA viral load (VL) rebound. We used longitudinal data from 2006 to 2017 to evaluate the impact of sociodemographic, behavioral, social-structural, and clinical factors on the hazard of viral rebound for women enrolled in the ACCESS study, a prospective cohort with systematic VL monitoring. Women were included if they achieved VL suppression (<50 copies/mL) following antiretroviral therapy (ART) initiation and had more than one study interview. Sociodemographic as well as substance use, social-structural, addiction treatment, and HIV clinical factors were evaluated as predictors of viral rebound (VL > 1000 copies/mL). Cox regressions using a recurrent events framework, time-varying covariates, robust standard errors, and a frailty component were used. Of the 185 women included, 62 (34%) experienced at least one viral rebound event over an 11-year period, accumulating a total of 87 viral rebound events. In adjusted analysis, stimulant use more than doubled the hazard of viral rebound (adjusted hazard ratio [AHR]: 2.35, 95% confidence interval [CI]: 1.07–5.14) while the only factor protective against viral rebound was receipt of opioid agonist treatment (OAT) in the past six months (AHR: 0.46, 95% CI: 0.26–0.81). After adjusting for ART adherence in the past six months, the effect of OAT was attenuated (AHR: 0.57, 95% CI: 0.32–1.02). Efforts to improve access to and retention within OAT programs and decrease stimulant use may improve rates of viral suppression for HIV-positive women who use illicit drugs.