title: Increased Prevalence of Controlled Viremia and Decreased Rates of HIV Drug Resistance Among HIV-Positive People Who Use Illicit Drugs During a Community-wide Treatment-as-Prevention Initiative.
abstract: BACKGROUND
  Although treatment-as prevention (TasP) is a new cornerstone of global human immunodeficiency virus (HIV)-AIDS strategies, its effect among HIV-positive people who use illicit drugs (PWUD) has yet to be evaluated. We sought to describe longitudinal trends in exposure to antiretroviral therapy (ART), plasma HIV-1 RNA viral load (VL) and HIV drug resistance during a community-wide TasP intervention.
  
  
  METHODS
  We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a prospective cohort of HIV-positive PWUD linked to HIV clinical monitoring records. We estimated longitudinal changes in the proportion of individuals with VL <50 copies/mL and rates of HIV drug resistance using generalized estimating equations (GEE) and extended Cox models.
  
  
  RESULTS
  Between 1 January 2006 and 30 June 2014, 819 individuals were recruited and contributed 1 or more VL observation. During that time, the proportion of individuals with nondetectable VL increased from 28% to 63% (P < .001). In a multivariable GEE model, later year of observation was independently and positively associated with greater likelihood of nondetectable VL (adjusted odds ratio = 1.20 per year; P < .001). Although the proportion of individuals on ART increased, the incidence of HIV drug resistance declined (adjusted hazard ratio = 0.78 per year; P = .011).
  
  
  CONCLUSIONS
  We observed significant improvements in several measures of exposure to ART and virologic status, including declines in HIV drug resistance, in this large long-running community-recruited cohort of HIV-seropositive illicit drug users during a community-wide ART expansion intervention. Our findings support continued efforts to scale up ART coverage among HIV-positive PWUD.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Bob
authors.initials: B
authors.lastname: Hogg
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital.
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: P Richard
authors.initials: PR
authors.lastname: Harrigan
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003695:Delivery of Health Care; D024882:Drug Resistance, Viral; D055030:Drug Users; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D013287:Illicit Drugs; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D014766:Viremia / Q000453:epidemiology* / Q000821:virology
chemical_list: D019380:Anti-HIV Agents; D013287:Illicit Drugs
keywords: HIV drug resistance; people who use illicit drugs; plasma HIV-1 RNA viral load; treatment-as-prevention