HIV treatment outcomes among people who acquired HIV via injecting drug use in the Asia-Pacific region: a longitudinal cohort study.

Win Min Han,Jun Yong Choi,Evy Yunihastuti,Suwimon Khusuwan,Oon Tek Ng,Yu‐Jiun Chan,Man‐Po Lee,Fujie Zhang,Sasisopin Kiertiburanakul,Nur Afiqah Mohd Salleh,Romanee Chaiwarith,Shashikala Sangle,Nagalingeswaran Kumarasamy,Jeremy Ross,Anchalee Avihingsanon,Rossana Ditangco,Awachana Jiamsakul,Tuti Parwati Merati ,Bùi Vũ Huy ,Cuong Duy ,Yasmin Gani

doi:10.1002/jia2.25736

Abstract

INTRODUCTIONData on HIV treatment outcomes in people who inject drugs (PWID) in the Asia‐Pacific are sparse despite the high burden of drug use. We assessed immunological and virological responses, AIDS‐defining events and mortality among PWID receiving antiretroviral therapy (ART).METHODSWe investigated HIV treatment outcomes among people who acquired HIV via injecting drug use in the TREAT Asia HIV Observational Database (TAHOD) between January 2003 and March 2019. Trends in CD4 count and viral suppression (VS, HIV viral load <1000 copies/mL) were assessed. Factors associated with mean CD4 changes were analysed using repeated measures linear regression, and combined AIDS event and mortality were analysed using survival analysis.RESULTSOf 622 PWID from 12 countries in the Asia‐Pacific, 93% were male and the median age at ART initiation was 31 years (IQR, 28 to 34). The median pre‐ART CD4 count was 71 cells/µL. CD4 counts increased over time, with a mean difference of 401 (95% CI, 372 to 457) cells/µL at year‐10 (n = 78). Higher follow‐up HIV viral load and pre‐ART CD4 counts were associated with smaller increases in CD4 counts. Among 361 PWID with ≥1 viral load after six months on ART, proportions with VS were 82%, 88% and 93% at 2‐, 5‐ and 10‐years following ART initiation. There were 52 new AIDS‐defining events and 50 deaths during 3347 person‐years of follow‐up (PYS) (incidence 3.05/100 PYS, 95% CI, 2.51 to 3.70). Previous AIDS or TB diagnosis, lower current CD4 count and adherence <95% were associated with combined new AIDS‐defining event and death.CONCLUSIONSDespite improved outcomes over time, our findings highlight the need for rapid ART initiation and adherence support among PWID within Asian settings.

Highlights

Data on HIV treatment outcomes in people who inject drugs (PWID) in the Asia-Pacific are sparse despite the high burden of drug use
Combined antiretroviral therapy (ART) has benefited millions of people living with HIV (PLHIV) and has reduced HIV-associated mortality, studies have shown that PWID with HIV are at risk for poorer ART adherence [3,4] and poorer virological and immunological responses to ART compared to the non-injecting individuals [5,6,7]
Characteristics associated with mean CD4 changes over time in the multivariate analysis were current HIV viral load 401 to 100,000 copies/mL and >100,000 copies/mL

Summary

Introduction

Data on HIV treatment outcomes in people who inject drugs (PWID) in the Asia-Pacific are sparse despite the high burden of drug use. The HIV cascade of care is a useful framework to monitor people living with HIV (PLHIV) from the first point of diagnosis to the ultimate goal of achieving high levels of HIV RNA-1 viral load suppression [2]. Between these steps, linkage to HIV care, and initiation and adherence to antiretroviral therapy (ART) constitute the overall framework of the HIV care cascade towards. Combined antiretroviral therapy (ART) has benefited millions of PLHIV and has reduced HIV-associated mortality, studies have shown that PWID with HIV are at risk for poorer ART adherence [3,4] and poorer virological and immunological responses to ART compared to the non-injecting individuals [5,6,7]

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