Page 1 Increasing rates of earlier antiretroviral treatment associated with elevated levels of optimal virologic response among HIV-positive illicit drug.

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Presentation transcript:

Page 1 Increasing rates of earlier antiretroviral treatment associated with elevated levels of optimal virologic response among HIV-positive illicit drug users during a Treatment-as-Prevention-based initiative in a Canadian setting M-J MILLOY, T KERR, R HOGG, S GUILLEMI, JSG MONTANER, E WOOD British Columbia Centre for Excellence in HIV/AIDS 8th International AIDS Society Conference on HIV pathogenesis, Treatment & Prevention Vancouver, 20 July 2015

Page 2 I have no conflicts of interest to declare.

Page 3 BACKGROUND TasP-based efforts seek to start PLWHA on HAART earlier in the disease course People who use illicit drugs (PWUD): sub- optimal access and adherence to HAART TasP-based efforts to scale-up HAART among PWUD have not been evaluated Will starting at higher CD4 (i.e., asymptomatic disease) degrade response to treatment?

Page 4 OBJECTIVES 1.Characterize temporal trends in CD4 at HAART initiation among PWUD during community-wide TasP 2.Test effect of initiating at higher CD4 on rates of virologic response in first year of treatment

Page 5 METHODS AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS) –Ongoing (2005-) observational prospective cohort –Recruited from community settings –Confidentially linked to comprehensive HIV TX records (ART, CD4, VL) Local setting: –Universal no-cost health care including ART –2005: Immediate HAART initiation

Page 6 RESULTS Between December 1, 2005 to June 1, 2013: –816 PWUD recruited –355 (44%): first HAART dispensation during period Among 355 participants: –130 (37%) non-male; 200 (56%) Caucasian –CD4: 200 cells/mL at initiation

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Page 11 CONCLUSIONS 1.Participants initiating HAART earlier –130 cells/mL (2005) to 330 c/mL (2013); peak 380 c/mL (2011) 2.Earlier initiation associated with better virologic response –Adjusted Hazards Ratio: 1.14 per 100 c/mL increase 3.Findings support continued scale-up of HAART among PWUD as part of efforts

Page 12 Acknowledgements Study participants for contributions to the research Current and past researchers and staff ACCESS supported by United States National Institutes of Health (R01-DA021525) M-JSM supported in part by US NIH (R01-DA021525) EW supported by a Tier 1 Canada Research Chair in Inner-City Medicine JSGM supported by grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01DA036307). He has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare