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Adherence and plasma HIV RNA response to antiretroviral therapy among HIV-seropositive injection drug users in a Canadian setting.

https://arctichealth.org/en/permalink/ahliterature135422
Source
AIDS Care. 2011 Aug;23(8):980-7
Publication Type
Article
Date
Aug-2011
Author
Seonaid Nolan
M-J Milloy
Ruth Zhang
Thomas Kerr
Robert S Hogg
Julio S G Montaner
Evan Wood
Author Affiliation
BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
Source
AIDS Care. 2011 Aug;23(8):980-7
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active - statistics & numerical data
Canada
Cohort Studies
Drug Users - psychology
Female
HIV Infections - blood - drug therapy - psychology
Humans
Kaplan-Meier Estimate
Male
Medication Adherence
Middle Aged
Patient compliance
Proportional Hazards Models
RNA, Viral - blood - drug effects
Substance Abuse, Intravenous
Treatment Outcome
Young Adult
Abstract
HIV-positive individuals who use injection drugs (IDU) may have lower rates of adherence to highly active antiretroviral therapy (ART). However, previous studies of factors associated with adherence to ART among IDU have been limited primarily to samples drawn from clinical settings and in areas with financial barriers to healthcare.We evaluated patterns of ART adherence and rates of plasma HIV RNA response among a Canadian cohort of community-recruited IDU. Using data from a community-recruited cohort of antiretroviral-naive HIV-infected IDU, we investigated ART adherence patterns based on prescription refill compliance and factors associated with time to plasma HIV-1 RNA suppression (
PubMed ID
21480010 View in PubMed
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Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care.

https://arctichealth.org/en/permalink/ahliterature106525
Source
J Epidemiol Community Health. 2014 Jan;68(1):93-6
Publication Type
Article
Date
Jan-2014
Author
Lindsey A Richardson
M-J S Milloy
Thomas H Kerr
Surita Parashar
Julio S G Montaner
Evan Wood
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, , Vancouver, Canada.
Source
J Epidemiol Community Health. 2014 Jan;68(1):93-6
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Antiretroviral Therapy, Highly Active - statistics & numerical data
British Columbia - epidemiology
Comorbidity
Drug Users - statistics & numerical data
Employment - psychology - statistics & numerical data
Female
HIV Seropositivity - drug therapy - mortality - psychology
Humans
Male
Multivariate Analysis
Prognosis
Proportional Hazards Models
Prospective Studies
Risk assessment
Sex Distribution
Universal Coverage
Young Adult
Abstract
Given the link between employment and mortality in the general population, we sought to assess this relationship among HIV-positive people who use illicit drugs in Vancouver, Canada.
Data were derived from a prospective cohort study of HIV seropositive people who use illicit drugs (n=666) during the period of May 1996-June 2010 linked to comprehensive clinical data in Vancouver, Canada, a setting where HIV care is delivered without charge. We estimated the relationship between employment and mortality using proportional hazards survival analysis, adjusting for relevant behavioural, clinical, social and socioeconomic factors.
In a multivariate survival model, a time-updated measure of full time, temporary or self-employment compared with no employment was significantly associated with a lower risk of death (adjusted HR=0.44, 95% CI 0.22 to 0.91). Results were robust to adjustment for relevant confounders, including age, injection and non-injection drug use, plasma viral load and baseline CD4 T-cell count.
These findings suggest that employment may be an important dimension of mortality risk of HIV-seropositive illicit drug users. The potentially health-promoting impacts of labour market involvement warrant further exploration given the widespread barriers to employment and persistently elevated levels of preventable mortality among this highly marginalised population.
PubMed ID
24153247 View in PubMed
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Health care services utilization stratified by virological and immunological markers of HIV: evidence from a universal health care setting.

https://arctichealth.org/en/permalink/ahliterature152742
Source
HIV Med. 2009 Feb;10(2):88-93
Publication Type
Article
Date
Feb-2009
Author
E F Druyts
B. Yip
V D Lima
T A Burke
D. Lesovski
K A Fernandes
C W McInnes
C A Rustad
J S G Montaner
R S Hogg
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada.
Source
HIV Med. 2009 Feb;10(2):88-93
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active - statistics & numerical data
British Columbia - epidemiology
CD4 Lymphocyte Count
Female
HIV Infections - epidemiology - immunology - virology
HIV-1
Health Services Accessibility - statistics & numerical data
Humans
Male
Patient Acceptance of Health Care - statistics & numerical data
Young Adult
Abstract
The aim of the study was to determine rates of utilization of in-patient, out-patient and laboratory services stratified by virological and immunological markers of HIV disease among patients on antiretroviral treatment in British Columbia, Canada.
We estimated resource utilization for in-patient visits, out-patient visits, and laboratory tests among patients initiating antiretroviral treatment between 1 April 1994 and 31 December 2000, with follow-up to 31 March 2001. Resource use was stratified by CD4 cell count and plasma HIV viral load (pVL) at the time of utilization and rates per 100 patient-years were calculated for each health care resource.
A total of 2718 patients were included in our analyses. The overall rates of in-patient visits, out-patient visits, and laboratory tests were 902, 3001 and 840 per 100 patient-years, respectively. Utilization was higher for patients with low CD4 cell counts and high pVLs when compared with patients with high CD4 cell counts and low pVLs.
Patients with low CD4 cell counts and high pVLs had the highest use of health care services. Regular follow-up with health care providers in an out-patient setting, allowing for proper monitoring and maintenance of HIV care, is important in minimizing unnecessary and potentially costly in-patient care.
Notes
Erratum In: HIV Med. 2009 Aug;10(7):459
PubMed ID
19200171 View in PubMed
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HIV related and non-HIV related mortality before and after the introduction of highly active antiretroviral therapy (HAART) in Norway compared to the general population.

https://arctichealth.org/en/permalink/ahliterature78406
Source
Scand J Infect Dis. 2007;39(1):51-7
Publication Type
Article
Date
2007
Author
Ormaasen Vidar
Sandvik Leiv
Dudman Susanne G
Bruun Johan N
Author Affiliation
Department of Infectious Diseases, Ullevål University Hospital, Oslo, Norway. vidar.ormaasen@medisin.uio.no
Source
Scand J Infect Dis. 2007;39(1):51-7
Date
2007
Language
English
Publication Type
Article
Keywords
AIDS-Related Opportunistic Infections - mortality
Adolescent
Adult
Aged
Aged, 80 and over
Antiretroviral Therapy, Highly Active - statistics & numerical data
Child
Child, Preschool
Female
HIV Infections - drug therapy - mortality
Humans
Infant
Male
Middle Aged
Mortality - trends
Norway - epidemiology
Population Surveillance
Risk
Survival Analysis
Abstract
The objective of the study was to compare the mortality in HIV infected individuals to the general population, and to explore the relative contribution of HIV to mortality before and after the introduction of highly active antiretroviral therapy (HAART). All HIV patients attending Ullevål University Hospital, Oslo, Norway before (cohort 1) and after (cohort 2) the introduction of HAART were included. Causes of deaths were classified as HIV related or not. Mortality in the Norwegian general population was standardized according to the distribution of age and gender in our cohorts. Ratios between mortality in our cohorts and the standardized mortality were calculated. The risk ratio (RR) for 5-y mortality compared to the general population was 22.6 (95% confidence interval (CI), 19.5-26.4) in cohort 1 (n = 782), and 3.96 (95% CI 2.25-6.97) in cohort 2 (n = 398). The non-HIV related mortality RR was 4.42 (95% CI 3.18-6.13) in cohort1 and 0.89 (95% CI 0.29-2.76) in cohort 2. Higher age and low CD4 cell count were associated with increased mortality. Thus, in the HAART era the mortality in HIV patients was reduced by 80%. However, the mortality in the HAART era was still 4 times higher than in the general population.
PubMed ID
17366013 View in PubMed
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Implementation and effectiveness of antiretroviral therapy in Greenland.

https://arctichealth.org/en/permalink/ahliterature93664
Source
Emerg Infect Dis. 2008 Jan;14(1):56-9
Publication Type
Article
Date
Jan-2008
Author
Lohse Nicolai
Ladefoged Karin
Obel Niels
Author Affiliation
Department of Clinical Epidemiology, Arhus University Hospital, Arhus, Denmark. nl@dce.au.dk
Source
Emerg Infect Dis. 2008 Jan;14(1):56-9
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active - statistics & numerical data
CD4 Lymphocyte Count - statistics & numerical data
Cohort Studies
Female
Greenland - epidemiology
HIV Infections - drug therapy - mortality
Humans
Male
Middle Aged
Abstract
Analyses from the Danish HIV Cohort Study showed that, despite comparable economic means and general education of healthcare personnel, antiretroviral treatment of HIV in Greenland began later and has been implemented at a slower pace with lower therapeutic effectiveness than in Denmark. However, implementation and quality of care improved considerably in recent years.
PubMed ID
18258077 View in PubMed
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Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up.

https://arctichealth.org/en/permalink/ahliterature190589
Source
AIDS. 2002 May 3;16(7):1051-8
Publication Type
Article
Date
May-3-2002
Author
Robert S Hogg
Katherine Heath
David Bangsberg
Benita Yip
Natasha Press
Michael V O'Shaughnessy
Julio S G Montaner
Author Affiliation
Division of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Source
AIDS. 2002 May 3;16(7):1051-8
Date
May-3-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antiretroviral Therapy, Highly Active - statistics & numerical data
British Columbia - epidemiology
CD4 Lymphocyte Count
Cause of Death
Data Collection
Drug Administration Schedule
Female
Follow-Up Studies
HIV Infections - drug therapy - mortality
HIV Protease Inhibitors - therapeutic use
Humans
Life tables
Male
Middle Aged
Patient Compliance - statistics & numerical data
Prognosis
Proportional Hazards Models
Prospective Studies
Reverse Transcriptase Inhibitors - therapeutic use
Risk
Treatment Outcome
Viral Load
Abstract
To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival.
Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number of months of follow-up. Intermittent therapy was defined as the participant having obtained less than 75% of their medication in the first 12 months.
Cumulative all-cause mortality rates from the start of triple drug antiretroviral therapy to 30 September 2000.
As of 30 September 2000, 106 subjects had died. Cumulative mortality was 3.9% (+/- 0.5%) at 12 months. In a multivariate model, after controlling for other variables that were significant in the univariate analyses each 100 cell decrement in baseline CD4 cell count and the intermittent use of antiretroviral drugs were associated with increased mortality with risk ratios of 1.31 [95% confidence interval (CI), 1.16-1.49; P
Notes
Comment In: AIDS. 2003;17 Suppl 4:S123-415080199
PubMed ID
11953472 View in PubMed
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Polypharmacy in HIV: impact of data source and gender on reported drug utilization.

https://arctichealth.org/en/permalink/ahliterature176767
Source
AIDS Patient Care STDS. 2004 Oct;18(10):568-86
Publication Type
Article
Date
Oct-2004
Author
Michelle D Furler
Thomas R Einarson
Sharon Walmsley
Margaret Millson
Reina Bendayan
Author Affiliation
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Source
AIDS Patient Care STDS. 2004 Oct;18(10):568-86
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Adult
Anti-Retroviral Agents - administration & dosage - classification - therapeutic use
Antiretroviral Therapy, Highly Active - statistics & numerical data
Complementary Therapies - statistics & numerical data
Cross-Sectional Studies
Databases, Factual
Female
HIV Infections - drug therapy - therapy
Humans
Male
Middle Aged
Nonprescription Drugs - administration & dosage - therapeutic use
Ontario
Outpatient Clinics, Hospital
Polypharmacy
Prevalence
Sex Distribution
Street Drugs
Abstract
Drug use in HIV is complex and may involve multiple therapeutic and nontherapeutic agents including prescription, over-the-counter, complementary and alternative medicine, and social/recreational drugs. This study was designed to assess the extent of such drug use in HIV-infected men and women. One hundred four adults were recruited through the HIV Ontario Observational Database from HIV outpatient clinics throughout Ontario, Canada. Patient demographics and data on drug use and physician awareness of drug use were collected through in-person interviews and medical chart review. All patient interviews and 96% of medical charts revealed the use of at least one drug. Eighty-five percent of patients reported use of antiretroviral medications; nearly 70% used highly active antiretroviral therapy. Patients used significantly more drugs by patient report (15.7 +/- 7.7) than by medical chart review (8.4 +/- 5.0) reporting up to 39 drugs per person. Pill burden was substantial, averaging 20.7 +/- 12.5 and ranged up to 69 "pills-per-day." Patient-reported physician awareness of drug use was highest for prescription drugs and lowest for social/recreational drugs; correspondingly agreement between medical chart and patient report ranged from 80% for antiretrovirals to 10% for non-prescribed drugs. The drug and pill burden faced by patients with HIV is considerable. Prevalence of use for specific drug classes varied with both data source and gender while number of drugs used differed only by data source. Our findings emphasize the complexity of pharmacotherapy in HIV and the need for comprehensive drug assessment, particularly because of the risks of drug-drug interactions and decreased adherence secondary to therapeutic complexity.
PubMed ID
15630785 View in PubMed
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Rates of initial virological suppression and subsequent virological failure after initiating highly active antiretroviral therapy: the impact of aboriginal ethnicity and injection drug use.

https://arctichealth.org/en/permalink/ahliterature138354
Source
Curr HIV Res. 2010 Dec;8(8):649-58
Publication Type
Article
Date
Dec-2010
Author
L J Martin
S. Houston
Y. Yasui
T C Wild
L D Saunders
Author Affiliation
Department of Public Health Sciences, School of Public Health, University of Alberta, Alberta, Canada. leah.martin@ualberta.ca
Source
Curr HIV Res. 2010 Dec;8(8):649-58
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Alberta - ethnology
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active - statistics & numerical data
Cohort Studies
Female
HIV Infections - drug therapy - mortality - virology
HIV-1 - physiology
Humans
Male
Patient compliance
Population Groups - statistics & numerical data
Substance Abuse, Intravenous - drug therapy - virology
Treatment Outcome
Abstract
To compare rates of initial virological suppression and subsequent virological failure by Aboriginal ethnicity after starting highly active antiretroviral therapy (HAART).
We conducted a retrospective cohort study of antiretroviral-naïve HIV-patients starting HAART in January 1999-June 2005 (baseline), followed until December 31, 2005 in Alberta, Canada. We compared the odds of achieving initial virological suppression (viral load 1000 copies/mL) by Aboriginal ethnicity using cumulative incidence curves and Cox proportional hazards models. Sex, injection drug use as an HIV exposure category (IDU), baseline age, CD4 cell count, viral load, calendar year, and HAART regimen were considered as potential confounders.
Of 461 study patients, 37% were Aboriginal and 48% were IDUs; 71% achieved initial virological suppression and were followed for 730.4 person-years. After adjusting for confounding variables, compared to non-Aboriginals with other exposures, the odds of achieving initial virological suppression were lower for Aboriginal IDUs (odds ratio (OR)=0.33, 95% CI=0.19-0.60, p=0.0002), non-Aboriginal IDUs (OR=0.30, 95% CI=0.15-0.60, p=0.0006), and Aboriginals with other exposures (OR=0.38, 95% CI=0.21-0.67, p=0.0009). Among those achieving suppression, Aboriginals experienced higher virological failure rates =1 year after suppression (hazard ratio=3.35, 95% CI=1.68-6.65, p=0.0006).
Future research should investigate adherence among Aboriginals and IDUs treated with HAART and explore their treatment experiences to assess ways to improve outcomes.
PubMed ID
21187007 View in PubMed
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Socio-economic- and sex-related disparities in rates of hospital admission among patients with HIV infection in Ontario: a population-based study.

https://arctichealth.org/en/permalink/ahliterature128361
Source
Open Med. 2012;6(4):e146-54
Publication Type
Article
Date
2012
Author
Tony Antoniou
Brandon Zagorski
Mona R Loutfy
Carol Strike
Richard H Glazier
Author Affiliation
Department of Family and Community Medicine at St. Michael’s Hospital and an Assistant Professor in the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. tantoniou@smh.ca
Source
Open Med. 2012;6(4):e146-54
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active - statistics & numerical data
Cohort Studies
Demography
Emigrants and Immigrants - statistics & numerical data
Female
HIV Infections - epidemiology - therapy
Health Services - statistics & numerical data - utilization
Health Status Disparities
Hospitalization - statistics & numerical data
Humans
Inpatients - statistics & numerical data
Male
Ontario - epidemiology
Registries
Risk assessment
Sex Factors
Socioeconomic Factors
Abstract
Among people living with HIV infection in the era of combination antiretroviral therapy (cART), admission to hospital may indicate inadequate community-based care. As such, population-based assessments of the utilization of inpatient services represent a necessary component of evaluating the quality of HIV-related care.
We used a validated algorithm to search Ontario's administrative health care databases for all persons living with HIV infection aged 18 years or older between 1992/93 and 2008/09. We then conducted a population-based study using time-series and longitudinal analyses to first quantify the immediate effect of cART on hospital admission rates and then analyze recent trends (for 2002/03 to 2008/09) in rates of total and HIV-related admissions.
The introduction of cART in 1996/97 was associated with more pronounced reductions in the rate of hospital admissions among men than among women (for total admissions, -89.9 v. -60.5 per 1000 persons living with HIV infection, p = 0.003; for HIV-related admissions, -56.9 v. -36.3 per 1000 persons living with HIV infection, p
Notes
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PubMed ID
23687530 View in PubMed
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13 records – page 1 of 2.