title: Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: an observational cohort study.
abstract: OBJECTIVE
  Studies have demonstrated the central function of plasma HIV-1 RNA viral load (pVL) levels on determining the risk of HIV disease progression and transmission. However, there is limited empirical research on virologic outcomes among sex workers who use illicit drugs (SW-DU).
  
  
  METHODS
  Data were derived from the AIDS Care Cohort to evaluate Exposure to Survival Services, a cohort of HIV-positive illicit drug users. Using generalised estimating equations, we studied the longitudinal relationship between sex work and pVL suppression. We also tested whether adherence to antiretroviral therapy (ART) mediated the relationship between sex work and pVL suppression.
  
  
  RESULTS
  Between May 1996 and May 2012, 587 ART-exposed participants (2224 person-years of observation) were included in the study, among whom 127 (21.6%) reported sex work. In a time-updated multivariate model adjusted for various demographic, socioeconomic and clinical confounders (eg, gender, incarceration, CD4 cell count), SW-DU had an independently reduced odds of pVL suppression compared to non-SW-DU (adjusted OR (AOR)=0.66; 95% CI 0.45 to 0.96). However, adding ART adherence to the multivariate model eliminated this association (p>0.05), suggesting adherence mediated the relationship between sex work and pVL suppression.
  
  
  CONCLUSIONS
  Evidence-based interventions to improve adherence to ART among SW-DU are urgently needed to help produce the maximum HIV treatment and prevention benefit of ART among this highly vulnerable population.
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Lianping
authors: L
authors: Ti
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
authors: M-J
authors: MJ
authors: Milloy
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Kate
authors: K
authors: Shannon
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Annick
authors: A
authors: Simo
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors: Robert S
authors: RS
authors: Hogg
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Sylvia
authors: S
authors: Guillemi
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Julio
authors: J
authors: Montaner
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Thomas
authors: T
authors: Kerr
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Evan
authors: E
authors: Wood
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D018450:Disease Progression; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000302:isolation & purification; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D012923:Social Class; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D013287:Illicit Drugs; D012367:RNA, Viral
keywords: Drug Addiction; Drug Misuse; Epidemiology (Clinical); HIV