TY - JOUR
T1 - Influence of Injection Drug Use-Related HIV Acquisition on CD4 Response to First Antiretroviral Therapy Regimen Among Virally Suppressed Individuals
AU - Calkins, Keri L.
AU - Lesko, Catherine R.
AU - Chander, Geetanjali
AU - Moore, Richard D.
AU - Lau, Bryan
N1 - Funding Information:
Received for publication August 3, 2017; accepted November 13, 2017. From the *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and †School of Medicine, Johns Hopkins University, Baltimore, MD. Supported by the National Institutes of Health (Grant Numbers U01-DA036935, P30-AI094189). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health. The authors have no conflicts of interest to disclose. Correspondence to: Keri L. Calkins, ScM, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 (e-mail: kcalkins@jhu.edu). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: The inflammatory effects of injection drug use (IDU) may result in an impaired immune response to antiretroviral therapy (ART). We examined CD4 response to first ART regimen among individuals in routine HIV care, stratified by IDU-related HIV acquisition. Setting: Cohort study including patients who initiated ART between 2000 and 2015 in the Johns Hopkins HIV Clinic. Methods: We followed individuals from ART initiation until death, loss to follow-up, loss of viral load suppression (<500 copies/mL), or administrative censoring. We described CD4 trajectories after ART initiation using inverse probability weighted quantile regression models with restricted cubic splines for time. Weights accounted for differences in baseline characteristics of persons comparing those with IDU-related HIV acquisition to those with other HIV acquisition risks (non-IDU) and possible nondifferential censoring due to death, loss to follow-up, or loss of viral load suppression. We also examined CD4 response by strata of CD4 at ART initiation (≤200, 201-350, >350). Results: Of 1244 patients initiating ART, 30.4% were IDU. Absolute CD4 cell difference at the 50th percentile comparing IDU with non-IDU was 225 cells [95% confidence interval (CI): 263 to 35], 266 cells (95% CI: 2141 to 16), and 291 cells (95% CI: 2190 to 25) at 2, 4, and 6 years after ART initiation, respectively. Results were similar (non-IDU with slightly higher CD4 count, but not statistically significant differences) at other percentiles and stratified by baseline CD4. Conclusions: CD4 recovery after ART initiation was similar for IDU and non-IDU, conditional on consistent viral load suppression.
AB - Background: The inflammatory effects of injection drug use (IDU) may result in an impaired immune response to antiretroviral therapy (ART). We examined CD4 response to first ART regimen among individuals in routine HIV care, stratified by IDU-related HIV acquisition. Setting: Cohort study including patients who initiated ART between 2000 and 2015 in the Johns Hopkins HIV Clinic. Methods: We followed individuals from ART initiation until death, loss to follow-up, loss of viral load suppression (<500 copies/mL), or administrative censoring. We described CD4 trajectories after ART initiation using inverse probability weighted quantile regression models with restricted cubic splines for time. Weights accounted for differences in baseline characteristics of persons comparing those with IDU-related HIV acquisition to those with other HIV acquisition risks (non-IDU) and possible nondifferential censoring due to death, loss to follow-up, or loss of viral load suppression. We also examined CD4 response by strata of CD4 at ART initiation (≤200, 201-350, >350). Results: Of 1244 patients initiating ART, 30.4% were IDU. Absolute CD4 cell difference at the 50th percentile comparing IDU with non-IDU was 225 cells [95% confidence interval (CI): 263 to 35], 266 cells (95% CI: 2141 to 16), and 291 cells (95% CI: 2190 to 25) at 2, 4, and 6 years after ART initiation, respectively. Results were similar (non-IDU with slightly higher CD4 count, but not statistically significant differences) at other percentiles and stratified by baseline CD4. Conclusions: CD4 recovery after ART initiation was similar for IDU and non-IDU, conditional on consistent viral load suppression.
KW - Antiretroviral therapy
KW - CD4
KW - Immune reconstitution
KW - Injection drug use
KW - Viral suppression
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U2 - 10.1097/QAI.0000000000001607
DO - 10.1097/QAI.0000000000001607
M3 - Article
C2 - 29210833
AN - SCOPUS:85061856137
SN - 1525-4135
VL - 77
SP - 317
EP - 324
JO - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
JF - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
IS - 3
ER -