Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users
Identifieur interne : 001479 ( Pmc/Corpus ); précédent : 001478; suivant : 001480Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users
Auteurs : Scott E. Hadland ; M.-J. Milloy ; Thomas Kerr ; Ruth Zhang ; Silvia Guillemi ; Robert S. Hogg ; Julio S. Montaner ; Evan WoodSource :
- AIDS Patient Care and STDs [ 1087-2914 ] ; 2012.
Abstract
Previous studies of adherence to antiretroviral therapy (ART) for HIV among young injection drug users (IDU) have been limited because financial barriers to care disproportionately affect youth, thus confounding results. This study examines adherence among IDU in a unique setting where all medical care is provided free-of-charge. From May 1996 to April 2008, we followed a prospective cohort of 545 HIV-positive IDU of 18 years of age or older in Vancouver, Canada. Using generalized estimating equations (GEE), we studied the association between age and adherence (obtaining ART≥95% of the prescribed time), controlling for potential confounders. Using Cox proportional hazards regression, we also studied the effect of age on time to viral load suppression (<500 copies per milliliter), and examined adherence as a mediating variable. Five hundred forty-five participants were followed for a median of 23.8 months (interquartile range [IQR]=8.5–91.6 months). Odds of adherence were significantly lower among younger IDU (adjusted odds ratio [AOR]=0.76 per 10 years younger; 95% confidence interval [CI], 0.65–0.89). Younger IDU were also less likely to achieve viral load suppression (adjusted hazard ratio [AHR]=0.75 per 10 years younger; 95% CI, 0.64–0.88). Adding adherence to the model eliminated this association with age, supporting the role of adherence as a mediating variable. Despite absence of financial barriers, younger IDU remain less likely to adhere to ART, resulting in inferior viral load suppression. Interventions should carefully address the unique needs of young HIV-positive IDU.
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DOI: 10.1089/apc.2011.0196
PubMed: 22429003
PubMed Central: 3366333
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PMC:3366333Le document en format XML
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<series><title level="j">AIDS Patient Care and STDs</title>
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<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<p>Previous studies of adherence to antiretroviral therapy (ART) for HIV among young injection drug users (IDU) have been limited because financial barriers to care disproportionately affect youth, thus confounding results. This study examines adherence among IDU in a unique setting where all medical care is provided free-of-charge. From May 1996 to April 2008, we followed a prospective cohort of 545 HIV-positive IDU of 18 years of age or older in Vancouver, Canada. Using generalized estimating equations (GEE), we studied the association between age and adherence (obtaining ART≥95% of the prescribed time), controlling for potential confounders. Using Cox proportional hazards regression, we also studied the effect of age on time to viral load suppression (<500 copies per milliliter), and examined adherence as a mediating variable. Five hundred forty-five participants were followed for a median of 23.8 months (interquartile range [IQR]=8.5–91.6 months). Odds of adherence were significantly lower among younger IDU (adjusted odds ratio [AOR]=0.76 per 10 years younger; 95% confidence interval [CI], 0.65–0.89). Younger IDU were also less likely to achieve viral load suppression (adjusted hazard ratio [AHR]=0.75 per 10 years younger; 95% CI, 0.64–0.88). Adding adherence to the model eliminated this association with age, supporting the role of adherence as a mediating variable. Despite absence of financial barriers, younger IDU remain less likely to adhere to ART, resulting in inferior viral load suppression. Interventions should carefully address the unique needs of young HIV-positive IDU.</p>
</div>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">AIDS Patient Care STDS</journal-id>
<journal-id journal-id-type="iso-abbrev">AIDS Patient Care STDS</journal-id>
<journal-id journal-id-type="publisher-id">apc</journal-id>
<journal-title-group><journal-title>AIDS Patient Care and STDs</journal-title>
</journal-title-group>
<issn pub-type="ppub">1087-2914</issn>
<issn pub-type="epub">1557-7449</issn>
<publisher><publisher-name>Mary Ann Liebert, Inc.</publisher-name>
<publisher-loc>140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">22429003</article-id>
<article-id pub-id-type="pmc">3366333</article-id>
<article-id pub-id-type="publisher-id">10.1089/apc.2011.0196</article-id>
<article-id pub-id-type="doi">10.1089/apc.2011.0196</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Behavioral and Psychosocial Research</subject>
</subj-group>
</article-categories>
<title-group><article-title>Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Hadland</surname>
<given-names>Scott E.</given-names>
</name>
<degrees>M.D., M.P.H.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1,</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Milloy</surname>
<given-names>M.-J.</given-names>
</name>
<degrees>M.Sc.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3,</sup>
</xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kerr</surname>
<given-names>Thomas</given-names>
</name>
<degrees>Ph.D.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3,</sup>
</xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zhang</surname>
<given-names>Ruth</given-names>
</name>
<degrees>M.Sc.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Guillemi</surname>
<given-names>Silvia</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3,</sup>
</xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hogg</surname>
<given-names>Robert S.</given-names>
</name>
<degrees>Ph.D.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3,</sup>
</xref>
<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Montaner</surname>
<given-names>Julio S.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3,</sup>
</xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Wood</surname>
<given-names>Evan</given-names>
</name>
<degrees>M.D., Ph.D.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3,</sup>
</xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<aff id="aff1"><label><sup>1</sup>
</label>
Department of Pediatrics,<institution>Boston Medical Center</institution>
, Boston, Massachusetts.</aff>
<aff id="aff2"><label><sup>2</sup>
</label>
Department of Medicine,<institution>Children's Hospital Boston</institution>
, Boston, Massachusetts.</aff>
<aff id="aff3"><label><sup>3</sup>
</label>
British Columbia Centre for Excellence in HIV/AIDS,<institution>St. Paul's Hospital</institution>
, Vancouver, British Columbia.</aff>
<aff id="aff4"><label><sup>4</sup>
</label>
School of Population and Public Health,<institution>University of British Columbia</institution>
, Mather Building, Vancouver, British Columbia.</aff>
<aff id="aff5"><label><sup>5</sup>
</label>
Faculty of Medicine,<institution>University of British Columbia</institution>
, Mather Building, Vancouver, British Columbia.</aff>
<aff id="aff6"><label><sup>6</sup>
</label>
Faculty of Health Sciences,<institution>Simon Fraser University</institution>
, Burnaby, British Columbia.</aff>
</contrib-group>
<author-notes><corresp>Address correspondence to: <italic>Evan Wood, M.D., Ph.D., BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. E-mail:</italic>
<email xlink:href="mailto:uhri-ew@cfenet.ubc.ca">uhri-ew@cfenet.ubc.ca</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>5</month>
<year>2012</year>
<pmc-comment>string-date: May 2012</pmc-comment>
</pub-date>
<volume>26</volume>
<issue>5</issue>
<fpage>274</fpage>
<lpage>280</lpage>
<permissions><copyright-statement>Copyright 2012, Mary Ann Liebert, Inc.</copyright-statement>
<copyright-year>2012</copyright-year>
</permissions>
<self-uri xlink:type="simple" xlink:href="apc.2011.0196.pdf"></self-uri>
<abstract><title>Abstract</title>
<p>Previous studies of adherence to antiretroviral therapy (ART) for HIV among young injection drug users (IDU) have been limited because financial barriers to care disproportionately affect youth, thus confounding results. This study examines adherence among IDU in a unique setting where all medical care is provided free-of-charge. From May 1996 to April 2008, we followed a prospective cohort of 545 HIV-positive IDU of 18 years of age or older in Vancouver, Canada. Using generalized estimating equations (GEE), we studied the association between age and adherence (obtaining ART≥95% of the prescribed time), controlling for potential confounders. Using Cox proportional hazards regression, we also studied the effect of age on time to viral load suppression (<500 copies per milliliter), and examined adherence as a mediating variable. Five hundred forty-five participants were followed for a median of 23.8 months (interquartile range [IQR]=8.5–91.6 months). Odds of adherence were significantly lower among younger IDU (adjusted odds ratio [AOR]=0.76 per 10 years younger; 95% confidence interval [CI], 0.65–0.89). Younger IDU were also less likely to achieve viral load suppression (adjusted hazard ratio [AHR]=0.75 per 10 years younger; 95% CI, 0.64–0.88). Adding adherence to the model eliminated this association with age, supporting the role of adherence as a mediating variable. Despite absence of financial barriers, younger IDU remain less likely to adhere to ART, resulting in inferior viral load suppression. Interventions should carefully address the unique needs of young HIV-positive IDU.</p>
</abstract>
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