Svilen Konov, HIV i-Base

In this study the researchers examined the impact of IDU status and a series of clinical indicators on immunologic response. The treatment outcomes of treatment naïve adults (≥18 years old) initiating HAART after the year 2000 were assessed.

The clinical indicators used were:

1) Having <3 versus >3 CD4 count measurements in the first year of follow-up;

2) Having <3 versus >3 viral load measurements in the first year of follow-up;

3) Having a genotypic resistance testing done at baseline requested by the enrolling doctor in samples with viral load >250 copies/mL;

4) Having started therapy with <200 cells/mm3 CD4 cell count;

5) Having started on non-recommended HAART;

6) Having achieved viral suppression at 6 months since therapy initiation.

The model was adjusted for sex, age, CD4 cell count, viral load at baseline, and adherence to therapy during the first 6 months. Immunologic response was defined as the percent change in the 12-month CD4 cell count from the CD4 at baseline. Because the response was categorised as percent change >100%, percent change >0% and <100% and percent change <0%, a partial proportional odds model was used.

402 out of1633 (25%) of the people participating in the study reported IDU status. IDU were more likely to be female, younger, have adherence <95% during the first 6 months, <3 CD4 cell count and <3 viral load measurements during the first year on HAART, having started HAART with a CD4 cell count of 160 cells/mm3, and against all odds, being able to achieve suppression at 6 months since the initiation of HAART (P <0.01). The multivariate model (Table 2) estimated that IDU versus non-IDU immunologic responses did not differ significantly when stratified by the clinical indicators. Of note, as seen in the table, IDU and non-IDU had similar overall responses to HAART when stratified by adherence rates. This clearly indicates that a change in the general discourse on the benefits of HAART in the IDU population is necessary.

Table 2: Comparison of immunological and virological responses to ART between IDUs and non-IDUs based on level of adherence

Ref: Lima V et al. Similar Immunologic Responses to Modern HAART among IDU and Non-IDU in a Populational Setting. Poster abstract 516.

http://www.retroconference.org/2010/Abstracts/38235.htm