Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 The impact of ongoing illicit drug use on virologic suppression in HIV-infected injection drug users receiving HAART Authors: Harout Tossonian, Jesse.

Published byShona Dickerson Modified over 8 years ago

Similar presentations

Presentation on theme: "1 The impact of ongoing illicit drug use on virologic suppression in HIV-infected injection drug users receiving HAART Authors: Harout Tossonian, Jesse."— Presentation transcript:

1 1 The impact of ongoing illicit drug use on virologic suppression in HIV-infected injection drug users receiving HAART Authors: Harout Tossonian, Jesse Raffa, Jason Grebely, Behroz Rashidi, Stanley DeVlaming, Brian Conway XVII International AIDS Conference Mexico City Date: August 07, 2008

2 2 Introduction   Injection drug users (IDUs): Increasing globally 125,000 across Canada 6,000 on Downtown East Side of Vancouver Cocaine and heroin predominant drugs used   Antiretroviral therapy: May be less adherent to HAART May not respond to treatment as other patient groups May be less likely to achieve virologic suppression

3 Introduction   Studies : IDUs as likely to achieve virologic suppression as non-IDUs (Palepu et al., AIDS 2001) Active drug use associated with lower adherence to HAART and poorer clinical outcomes (Lucas et al, JAIDS 2001; Arnsten et al, J Gen Intern Med 2002; Palepu et al, JAIDS 2003) Within directly observed therapy (DOT) program, active drug use not associated with virologic failure (Conway et al, CID 2004) Within DOT setting, active drug use associated with non- adherence and non-retention but not with virologic failure (Lucas et al., AIDS Patient Care STDS 2007)

4 4 Objective To evaluate the impact of ongoing illicit drug use on virologic suppression in HIV- infected IDUs receiving HAART

5 5 Methods   Study and Population: Longitudinal prospective and retrospective cohort study HIV-infected IDUs who were prescribed HAART Pender Community Health Centre Downtown East Side of Vancouver, Canada Multidisciplinary approach   Regimens: DOT or self-administered therapy Methadone maintenance treatment Between August 1996 and August 2007 NNRTIs or PIs along with 2 NRTIs

6 6 Methods   Urine specimens for toxicology assays were analyzed: Amphetamines (A) Benzodiazepines (B) Cocaine (C) Heroin/opiates (O)   Ability to achieve virologic suppression was measured as a function of having a positive or negative (cumulative) urinalysis: At baseline During 6 months prior to treatment initiation During 12 months prior to treatment initiation

7 7 Methods   Virologic suppression: Measured at weeks 24 and 48 Based on intent-to-treat analysis HIV RNA < 400 copies/mL   Illicit drug use associated with virologic suppression: Multiple logistic regression models Adjusting for potential confounders Including age, sex, hepatitis C status, DOT, dosing frequency, regimen group, continuity of treatment, pre- HAART exposure and line of therapy

8 8 Results Number of patients Number of patients Males (%) Males (%) Mean age in years (SD) Mean age in years (SD) Hepatitis C antibody positive (%) Hepatitis C antibody positive (%) Mean CD4 (SD) cells/mm 3 Mean CD4 (SD) cells/mm 3 Median Viral load (Q1-Q3) copies/mL Median Viral load (Q1-Q3) copies/mL Treatment administration: DOT (%) Treatment administration: DOT (%) Pre-HAART exposure (%) Pre-HAART exposure (%) Median regimen duration in years (Q1-Q3) Median regimen duration in years (Q1-Q3) Regimen based on: NRTIs/NNRTIs/PIs Regimen based on: NRTIs/NNRTIs/PIs Dosing frequency: Once/Twice/Thrice Dosing frequency: Once/Twice/Thrice Line of therapy: 1 st /2 nd /3 rd />3 rd Line of therapy: 1 st /2 nd /3 rd />3 rd133 79 (59) 37.3 (7.7) 130 (98) 235 (203) 235 (203) 33,400 (1,180 - >100,000) 115 (86) 35 (26) 1.00 (0.50-2.00) 5/21/10790/41/217/48/58/10 Baseline patient characteristics

9 9 Virologic suppression vs. positive or negative urinalysis (N=97) for illicit drugs at baseline A= Amphetamines; B= Benzodiazepines; C= Cocaine; O= Heroin/Opiates

10 10 Virologic suppression vs. positive or negative urinalysis (N=122) during the 6 months prior to treatment A= Amphetamines; B= Benzodiazepines; C= Cocaine; O= Heroin/Opiates

11 11 Virologic suppression vs. positive or negative urinalysis (N=133) during the 12 months prior to treatment A= Amphetamines; B= Benzodiazepines; C= Cocaine; O= Heroin/Opiates

12 12 Factors associated with virologic suppression at week 24Factor Adjusted Odds Ratio 95% C. I. p-value Baseline B 6 months B 12 months B Baseline C 6 months C 12 months C Baseline O 6 months O 12 months O Baseline A/B/C/O 6 months A/B/C/O 12 months A/B/C/O Baseline A/C/O 6 months A/C/O 12 months A/C/O 2.451.741.430.330.290.570.741.661.330.550.500.670.450.490.750.85-7.050.75-4.010.66-3.080.12-0.870.10-0.890.19-1.700.26-2.080.69-4.030.56-3.150.22-1.390.17-1.450.23-1.980.18-1.110.18-1.340.27-2.070.0960.190.360.0260.0300.320.570.260.520.210.200.470.0850.170.58

13 13 Factors associated with virologic suppression at week 24Factor Adjusted Odds Ratio 95% C. I. p-value Baseline B 6 months B 12 months B Baseline C 6 months C 12 months C Baseline O 6 months O 12 months O Baseline A/B/C/O 6 months A/B/C/O 12 months A/B/C/O Baseline A/C/O 6 months A/C/O 12 months A/C/O 2.451.741.430.330.290.570.741.661.330.550.500.670.450.490.750.85-7.050.75-4.010.66-3.080.12-0.870.10-0.890.19-1.700.26-2.080.69-4.030.56-3.150.22-1.390.17-1.450.23-1.980.18-1.110.18-1.340.27-2.070.0960.190.360.0260.0300.320.570.260.520.210.200.470.0850.170.58

14 14 Factor Adjusted Odds Ratio 95% C. I. p-value Baseline B 6 months B 12 months B Baseline C 6 months C 12 months C Baseline O 6 months O 12 months O Baseline A/B/C/O 6 months A/B/C/O 12 months A/B/C/O Baseline A/C/O 6 months A/C/O 12 months A/C/O 1.761.372.350.951.021.040.781.341.171.301.662.001.001.251.730.63-4.910.58-3.211.03-5.340.36-2.540.32-3.180.31-3.430.27-2.250.53-3.400.46-2.980.49-3.450.51-5.360.56-7.160.40-2.520.44-3.560.54-5.480.280.470.0420.920.980.950.640.540.740.600.400.290.990.670.36 Factors associated with virologic suppression at week 48

15 15 Factor Adjusted Odds Ratio 95% C. I. p-value Baseline B 6 months B 12 months B Baseline C 6 months C 12 months C Baseline O 6 months O 12 months O Baseline A/B/C/O 6 months A/B/C/O 12 months A/B/C/O Baseline A/C/O 6 months A/C/O 12 months A/C/O 1.761.372.350.951.021.040.781.341.171.301.662.001.001.251.730.63-4.910.58-3.211.03-5.340.36-2.540.32-3.180.31-3.430.27-2.250.53-3.400.46-2.980.49-3.450.51-5.360.56-7.160.40-2.520.44-3.560.54-5.480.280.470.0420.920.980.950.640.540.740.600.400.290.990.670.36 Factors associated with virologic suppression at week 48

16 16 Discussion   Similar rates of virologic suppression were achieved at weeks 24 and 48, in patients with positive and negative urinalyses for illicit drugs at baseline, as well as within the 6 and 12 months prior to treatment initiation   Having a positive urinalysis result for cocaine, at baseline and in the 6 months prior to treatment, was significantly associated with virologic failure at week 24

17 17 Discussion   Having a positive urinalysis result for benzodiazepines in the 12 months prior to treatment was significantly associated with virologic suppression at week 48, possibly linked to legitimate uses of benzodiazepines   Other illicit drug use was not associated with treatment failure at all other assessment points

18 18 Discussion   Structured programs for the delivery of HAART may be successful despite ongoing illicit drug use. Such use is not a contraindication to initiate HAART if treatment is medically indicated   Innovative or modified strategies (within the context of DOT) for the treatment of HIV infection among IDUs who abuse cocaine may be necessary to ensure optimal levels of virologic suppression are achieved in this population

19 19 Acknowledgements  Dr. Brian Conway  Mr. Jesse Raffa  Pender Community Health Centre  University of British Columbia  Boehringer Ingelheim Canada  Canadian Institutes of Health Research (CIHR)  AIDS 2008

Download ppt "1 The impact of ongoing illicit drug use on virologic suppression in HIV-infected injection drug users receiving HAART Authors: Harout Tossonian, Jesse."

Similar presentations

DACS 272 Neurologic deficits in the years following ART initiation among subjects in the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized.

DACS 272 Neurologic deficits in the years following ART initiation among subjects in the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized.
Objective of the DAP A) Specify an analysis plan that can be applied to a wide variety of clinical HIV resistance studies. B) Include both Intervention.

Objective of the DAP A) Specify an analysis plan that can be applied to a wide variety of clinical HIV resistance studies. B) Include both Intervention.
Mortality and causes of death among women living with HIV in the UK in the era of highly-active antiretroviral therapy Sara Croxford, A Kitching, M Kall,

Mortality and causes of death among women living with HIV in the UK in the era of highly-active antiretroviral therapy Sara Croxford, A Kitching, M Kall,
Delay from Testing HIV Positive until First HIV Care for Drug Users: Adverse Consequences and Possible Solutions Barbara J Turner MD, MSEd* John Fleishman.

Delay from Testing HIV Positive until First HIV Care for Drug Users: Adverse Consequences and Possible Solutions Barbara J Turner MD, MSEd* John Fleishman.
Journal Club Alcohol, Other Drugs, and Health: Current Evidence July–August 2013.

Journal Club Alcohol, Other Drugs, and Health: Current Evidence July–August 2013.
Treatment of HCV infection among active IDUs Jason Grebely, PhD Lecturer Viral Hepatitis Clinical Research Program National Centre in HIV Epidemiology.

Treatment of HCV infection among active IDUs Jason Grebely, PhD Lecturer Viral Hepatitis Clinical Research Program National Centre in HIV Epidemiology.
Patients in routine HIV clinical care at-risk for potentially transmitting HIV in the “test and treat” era of HIV prevention Crane, HM, Mimiaga, M, Feldman,

Patients in routine HIV clinical care at-risk for potentially transmitting HIV in the “test and treat” era of HIV prevention Crane, HM, Mimiaga, M, Feldman,
Cell- and Tissue-based Measures of Viral Persistence Are Associated with Immune Activation and PD-1-Expressing CD4+ T cells H Hatano 1, V Jain 1, PW Hunt.

Cell- and Tissue-based Measures of Viral Persistence Are Associated with Immune Activation and PD-1-Expressing CD4+ T cells H Hatano 1, V Jain 1, PW Hunt.
Persisting long term benefit of genotypic guided treatment in HIV infected patients failing HAART and Importance of Protease Inhibitor plasma levels. Viradapt.

Persisting long term benefit of genotypic guided treatment in HIV infected patients failing HAART and Importance of Protease Inhibitor plasma levels. Viradapt.
Introduction DCDOH supports HIV test and treat activities - increased number of HIV tests performed, emphasis on earlier linkage to care. Limited data.

Introduction DCDOH supports HIV test and treat activities - increased number of HIV tests performed, emphasis on earlier linkage to care. Limited data.
Page 1 HIV Treatment-as-Prevention (TasP) for people who use illicit drugs and implications for HCV TasP: The North American experience M-J MILLOY Research.

Page 1 HIV Treatment-as-Prevention (TasP) for people who use illicit drugs and implications for HCV TasP: The North American experience M-J MILLOY Research.
Patient Empowerment Impacts Medication Adherence among HIV-Positive Patients in the Veteran’s Health Administration Tan Pham 1,2,3, Kristin Mattocks 1,2,

Patient Empowerment Impacts Medication Adherence among HIV-Positive Patients in the Veteran’s Health Administration Tan Pham 1,2,3, Kristin Mattocks 1,2,
Page 1 Social and socio-economic benefits of antiretroviral therapy adherence among HIV-infected people who use illicit drugs in Vancouver, Canada Lindsey.

Page 1 Social and socio-economic benefits of antiretroviral therapy adherence among HIV-infected people who use illicit drugs in Vancouver, Canada Lindsey.
The Effect of Syphilis Co-infection on Clinical Outcomes in HIV-Infected Persons The Effect of Syphilis Co-infection on Clinical Outcomes in HIV-Infected.

The Effect of Syphilis Co-infection on Clinical Outcomes in HIV-Infected Persons The Effect of Syphilis Co-infection on Clinical Outcomes in HIV-Infected.
Assessing the Response to Hepatitis B Immunizations in HIV-Positive Adults: Results from the 550 Clinic cohort study Camila Calderon 1, Anupama Raghuram.

Assessing the Response to Hepatitis B Immunizations in HIV-Positive Adults: Results from the 550 Clinic cohort study Camila Calderon 1, Anupama Raghuram.
Slide 1 of 11 From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA. IAS–USA David Alain Wohl, MD Associate Professor of Medicine The University of.

Slide 1 of 11 From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA. IAS–USA David Alain Wohl, MD Associate Professor of Medicine The University of.
Baseline Antiretroviral Resistance Testing among HIV-Positive Injection Drug Users in a Canadian Setting Nadia Fairbairn 1 M-J Milloy 1 Thomas Kerr 1,

Baseline Antiretroviral Resistance Testing among HIV-Positive Injection Drug Users in a Canadian Setting Nadia Fairbairn 1 M-J Milloy 1 Thomas Kerr 1,
Www.aids2012.org Washington D.C., USA, JULY 22-27 2012 Rulin C. Hechter 1 MD,PhD Jean Q. Wang 1 PhD Margo A. Sidell 1 ScD William J. Towner 2 MD 1 Dept.

Washington D.C., USA, JULY Rulin C. Hechter 1 MD,PhD Jean Q. Wang 1 PhD Margo A. Sidell 1 ScD William J. Towner 2 MD 1 Dept.
Risk of Osteoporotic Fractures Associated with Cumulative Exposure to Tenofovir and Other Antiretroviral Agents Roger Bedimo, MD; Song Zhang, PhD; Henning.

Risk of Osteoporotic Fractures Associated with Cumulative Exposure to Tenofovir and Other Antiretroviral Agents Roger Bedimo, MD; Song Zhang, PhD; Henning.
Older and wiser: continued improvements in clinical outcome and highly active antiretroviral therapy (HAART) response in HIV-infected children in the UK.

Older and wiser: continued improvements in clinical outcome and highly active antiretroviral therapy (HAART) response in HIV-infected children in the UK.

Similar presentations

Ads by Google