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Longitudinal changes in engagement in care and viral suppression for HIV-infected injection drug users

Westergaard, Ryan P.a; Hess, Timothyb; Astemborski, Jacquiec; Mehta, Shruti H.c; Kirk, Gregory D.d

doi: 10.1097/QAD.0b013e328363bff2
Clinical Science

Objective: To examine temporal trends and predictors of linkage to HIV care, longitudinal retention in care and viral suppression among injection drug users (IDUs) infected with HIV.

Design: Community-based, prospective cohort study.

Methods: We prospectively studied 790 HIV-infected IDUs participating in the AIDS Linked to the Intravenous Experience (ALIVE) study from 1998 through 2011. IDUs were considered linked to care if they attended any HIV care visit during follow-up and retained in care if they reported HIV clinic attendance at every semi-annual study visit. We used logistic regression to identify predictors of poor retention in care and failure to achieve sustained viral suppression in response to ART.

Results: Of 790 HIV-infected IDUs studied, 740 (93.6%) were ever linked to care. The majority of IDUs (76.7%) received ART at some point during observation and of these, most (85.4%) achieved viral suppression. However, over a median of 8.7 years of follow-up, only 241 (30.5%) IDUs were continuously retained with no 6-month lapses in HIV care and only 63 (10.2%) had sustained viral suppression at every study visit after first receiving ART. Suboptimal engagement in care was associated with poor access to medical care, active drug use, and incarceration.

Conclusion: Compared with national estimates of retention in care and virologic suppression in the United States, IDUs are substantially less likely to remain fully engaged in HIV care. Strategies to optimize HIV care should acknowledge the elevated risk of poor engagement in care among IDUs.

aDepartments of Medicine and Population Health Sciences

bDepartment of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

cDepartment of Epidemiology

dDepartments of Medicine, Epidemiology and Oncology, Johns Hopkins University, Baltimore, Maryland, USA.

Correspondence to Ryan P. Westergaard, MD, PhD, MPH, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB 5220, Madison, WI 53705, USA. Tel: +1 608 265 7927; fax: +1 608 263 4464; e-mail:

Received 18 April, 2013

Revised 24 May, 2013

Accepted 29 May, 2013

© 2013 Lippincott Williams & Wilkins, Inc.