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Homelessness associated with lack of virologic control among active injection drug users in Vancouver, Canada
M.-J. Milloy, T. Kerr, J. Montaner, E. Wood
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
Background: Injection drug users (IDU) typically face greater risks of HIV-related morbidity and mortality. However, the effects of social and environmental factors on disease progression in a setting of universal access to antiretroviral therapy remain incompletely explored. We assessed the relationship between homelessness and viral suppression in a cohort of active IDU in Vancouver, Canada.
Methods: Data was derived from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), an ongoing prospective cohort of HIV-seropositive IDU. Using a manual backwards selection procedure to identify possible confounders, we fit a multivariate logistic regression model to estimate the association between reporting homelessness and having a plasma HIV RNA level below 50 copies per ml at baseline.
Results: Two-hundred seventy-five individuals were included in this analysis, including 103 (37.5%) women. At baseline, 67 (24.4%) reported they were currently homeless; their median plasma HIV RNA level was 7943 c/mL (Inter-quartile range [IQR]: 501.2 - 158489.3), compared to 1000 c/mL (IQR: 39.8 - 31622.8) among non-homeless participants. In a multivariate confounding model including measures of adherence and drug use in the preceding six months, homeless individuals had significantly lower odds of having viral loads below 50 copies per ml (Adjusted Odds Ratio = 0.33, 95% Confidence Interval: 0.14 - 0.78, p-value = 0.012).
Conclusions: In this community-recruited cohort of HIV-seropositive individuals, we observed a substantial level of homelessness, which was independently associated with lower odds of virologic control. Ongoing follow-up of this cohort should identify factors associated with non-suppression among homeless individuals.
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