title: Patterns of heroin and cocaine injection and plasma HIV-1 RNA suppression among a long-term cohort of injection drug users.
abstract: BACKGROUND
  Previous studies suggest that active drug use may compromise HIV treatment among HIV-positive injection drug users (IDU). However, little is known about the differential impacts of cocaine injection, heroin injection, and combined cocaine and heroin injection on plasma HIV-1 RNA suppression.
  
  
  METHODS
  Data were derived from a longstanding open prospective cohort of HIV-positive IDU in Vancouver, Canada. Kaplan-Meier methods and Cox proportional hazards regression were used to examine the impacts of different drug use patterns on rates of plasma HIV-1 RNA suppression.
  
  
  RESULTS
  Between May 1996 and April 2008, 267 antiretroviral (ART) naïve participants were seen for a median follow-up duration of 50.6 months after initiating ART. The incidence density of HIV-1 RNA suppression was 65.2 (95%CI: 57.0-74.2) per 100 person-years. In Kaplan-Meier analyses, compared to those who abstained from injecting, individuals injecting heroin, cocaine, or combined heroin/cocaine at baseline were significantly less likely to achieve viral suppression (all p<0.01). However, none of the drug use categories remained associated with a reduced rate of viral suppression when considered as time-updated variables (all p>0.05).
  
  
  CONCLUSIONS
  Active injecting at the time of ART initiation was associated with lower plasma HIV-1 RNA suppression rates; however, there was no difference in suppression rates when drug use patterns were examined over time. These findings imply that adherence interventions for active injectors should optimally be applied at the time of ART initiation.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D019970:Cocaine-Related Disorders / Q000097:blood / Q000150:complications / Q000821:virology*; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000235:genetics*; D006556:Heroin Dependence / Q000097:blood / Q000150:complications / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood* / Q000235:genetics; D015819:Substance Abuse, Intravenous / Q000097:blood / Q000150:complications / Q000821:virology*
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral