Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10 (1500) copies/ml among illicit drug users

Mary Clare Kennedy; Thomas H. Kerr; Evan Wood; Jeannie A. Shoveller; Julio S.G. Montaner; M. J.S. Milloy

doi:10.1097/QAD.0000000000001777

Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log₁₀ (1500) copies/ml among illicit drug users

Mary Clare Kennedy, Thomas H. Kerr, Evan Wood, Jeannie A. Shoveller, Julio S.G. Montaner, M. J.S. Milloy

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

Abstract

Objectives: Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log 10 (1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. Design: Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. Methods: We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log 10 (1500) copies/ml plasma in the previous 180 days. Results: Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log 10 (1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log 10 (1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). Conclusion: Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.

Original language	English
Pages (from-to)	1059-1067
Number of pages	9
Journal	AIDS
Volume	32
Issue number	8
DOIs	https://doi.org/10.1097/QAD.0000000000001777
Publication status	Published - May 15 2018
Externally published	Yes

Bibliographical note

Funding Information:
The authors would like to thank the study participants for their contribution to the research, as well as current and past researchers and staff. We would specifically like to thank Jennifer Matthews, Deborah Graham, Peter Vann, Steve Kain, Ana Prado, Tricia Collingham, and Sarah Sheridan for their research and administrative assistance. This study was supported by the United States National Institutes of Health (U01-DA021525). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, which supports E.W. M.C.K. is supported by a Social Science and Humanities Research Council Doctoral Award, a Mitacs Accelarate Award from Mitacs Canada and a University of British Columbia Public Scholars Initiative Award. M-J.S.M. is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award, a Michael Smith Foundation for Health Research Scholar Award, and the National Institutes of Drug Abuse (U01-DA0251525). His institution has received unstructured funding to support his research from NG Biomed, Ltd., a private firm seeking a government license to produce medical cannabis. T.H.K. is supported by a CIHR Foundation Grant (20R74326). J.S.G.M. is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (DP1-DA026182) from the National Institute of Drug Abuse (NIDA), at the US National Institutes of Health (NIH). He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Healthcare and Vancouver Coastal Health Authority. J.S.G.M.’s institution has received grants from Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck & Co., ViiV Healthcare and Abbvie.

Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.

ASJC Scopus Subject Areas

Immunology and Allergy
Immunology
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/QAD.0000000000001777

Cite this

@article{2f60c2008a0a495da73772fd34446523,

title = "Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10 (1500) copies/ml among illicit drug users",

abstract = "Objectives: Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log 10 (1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. Design: Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. Methods: We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log 10 (1500) copies/ml plasma in the previous 180 days. Results: Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log 10 (1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log 10 (1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). Conclusion: Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.",

author = "Kennedy, {Mary Clare} and Kerr, {Thomas H.} and Evan Wood and Shoveller, {Jeannie A.} and Montaner, {Julio S.G.} and Milloy, {M. J.S.}",

note = "Funding Information: The authors would like to thank the study participants for their contribution to the research, as well as current and past researchers and staff. We would specifically like to thank Jennifer Matthews, Deborah Graham, Peter Vann, Steve Kain, Ana Prado, Tricia Collingham, and Sarah Sheridan for their research and administrative assistance. This study was supported by the United States National Institutes of Health (U01-DA021525). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, which supports E.W. M.C.K. is supported by a Social Science and Humanities Research Council Doctoral Award, a Mitacs Accelarate Award from Mitacs Canada and a University of British Columbia Public Scholars Initiative Award. M-J.S.M. is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award, a Michael Smith Foundation for Health Research Scholar Award, and the National Institutes of Drug Abuse (U01-DA0251525). His institution has received unstructured funding to support his research from NG Biomed, Ltd., a private firm seeking a government license to produce medical cannabis. T.H.K. is supported by a CIHR Foundation Grant (20R74326). J.S.G.M. is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (DP1-DA026182) from the National Institute of Drug Abuse (NIDA), at the US National Institutes of Health (NIH). He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President{\textquoteright}s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Healthcare and Vancouver Coastal Health Authority. J.S.G.M.{\textquoteright}s institution has received grants from Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck & Co., ViiV Healthcare and Abbvie. Publisher Copyright: {\textcopyright} 2018 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2018",

month = may,

day = "15",

doi = "10.1097/QAD.0000000000001777",

language = "English",

volume = "32",

pages = "1059--1067",

journal = "AIDS",

issn = "0269-9370",

publisher = "Lippincott Williams and Wilkins",

number = "8",

}

TY - JOUR

T1 - Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10 (1500) copies/ml among illicit drug users

AU - Kennedy, Mary Clare

AU - Kerr, Thomas H.

AU - Wood, Evan

AU - Shoveller, Jeannie A.

AU - Montaner, Julio S.G.

AU - Milloy, M. J.S.

N1 - Funding Information: The authors would like to thank the study participants for their contribution to the research, as well as current and past researchers and staff. We would specifically like to thank Jennifer Matthews, Deborah Graham, Peter Vann, Steve Kain, Ana Prado, Tricia Collingham, and Sarah Sheridan for their research and administrative assistance. This study was supported by the United States National Institutes of Health (U01-DA021525). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, which supports E.W. M.C.K. is supported by a Social Science and Humanities Research Council Doctoral Award, a Mitacs Accelarate Award from Mitacs Canada and a University of British Columbia Public Scholars Initiative Award. M-J.S.M. is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award, a Michael Smith Foundation for Health Research Scholar Award, and the National Institutes of Drug Abuse (U01-DA0251525). His institution has received unstructured funding to support his research from NG Biomed, Ltd., a private firm seeking a government license to produce medical cannabis. T.H.K. is supported by a CIHR Foundation Grant (20R74326). J.S.G.M. is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (DP1-DA026182) from the National Institute of Drug Abuse (NIDA), at the US National Institutes of Health (NIH). He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Healthcare and Vancouver Coastal Health Authority. J.S.G.M.’s institution has received grants from Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck & Co., ViiV Healthcare and Abbvie. Publisher Copyright: © 2018 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2018/5/15

Y1 - 2018/5/15

N2 - Objectives: Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log 10 (1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. Design: Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. Methods: We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log 10 (1500) copies/ml plasma in the previous 180 days. Results: Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log 10 (1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log 10 (1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). Conclusion: Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.

AB - Objectives: Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log 10 (1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. Design: Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. Methods: We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log 10 (1500) copies/ml plasma in the previous 180 days. Results: Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log 10 (1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log 10 (1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). Conclusion: Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.

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