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Global Meta-analysis Confirms Suboptimal Retention and HIV Suppression in Drug Users
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IAS 2023, July 23-26, 2023. Brisbane
Mark Mascolini
People with HIV who inject drugs have significantly lower rates of retention in care and viral suppression than men who have sex with men (MSM) with HIV and the general population with HIV, according to meta-analysis of 133 studies from scores of countries [1]. Researchers from the University of Bristol and collaborators at other centers hope this massive analysis will give fresh impetus to development of interventions that improve retention and treatment outcomes in drug injectors.
The researchers used electronic databases to search for articles published between January 1, 2010 and February 16, 2021 that yielded data on viral suppression or retention in care among drug injectors who are HIV-positive or positive and receiving HIV treatment. They screened article titles and abstracts to identify those that met inclusion criteria then analyzed the full text of identified articles to select cross-sectional and HIV treatment cohort studies for inclusion. Outcomes of interest were (1) rates of retention in care/on antiretroviral therapy (ART) among people who inject drugs who are receiving HIV treatment, (2) rates of viral suppression for drug injectors living with HIV or receiving HIV treatment, and (3) odds ratios for how the first two outcomes differ between people who inject drugs and three other HIV groups: MSM, female sex workers, and the general population. The investigators converted retention durations to 12-month retention estimates and converted viral suppression thresholds to below 1000 copies.
The analysis focused on 133 studies, including 116 studies of viral suppression from 35 countries and 36 studies of retention in care/on ART from 15 countries. Studies came from East and Southeast Asia, South Asia, Central Asia, Eastern Europe, Western Europe, North America, and Latin America.
Two thirds of people who inject drugs were retained in care/on ART at 12 months (65.6%, 95% confidence interval [CI] 58.0 to 73.3). Analysis of 20 studies indicated that this retention rate significantly lagged that of MSM (odds ratio [OR] 0.61, 95% CI 0.42 to 0.91).
One third of people with HIV who inject drugs (33.0%, 95% CI 30.0 to 36.1) and half of those taking ART (52.8%, 95% CI 46.2 to 59.3) attained viral suppression. Twenty-eight studies indicated that viral suppression rates of drug injectors lay significantly below those of the general population with HIV (OR 0.61, 95% CI 0.49 to 0.76), while 35 studies indicated that their suppression rate significantly trailed that of MSM (OR 0.56, 95% CI 0.47 to 0.67). Thirty studies showed that the viral suppression rate of people with HIV who inject drugs and take ART was lower than in the general HIV population (OR 0.57, 95% CI 0.50 to 0.64). And 26 studies indicated that viral suppression in this drug injector group was lower than in MSM (OR 0.50, 95% CI 0.43 to 0.59).
The investigators concluded that rates of retention in care/on ART and viral suppression are suboptimal in people who inject drugs and do not measure up to rates in other HIV populations. They proposed that "focused interventions are urgently required to improve HIV treatment outcomes among people who inject drugs."
Reference
1. Mutai KK, Stone J, Fraser H, et al. HIV treatment outcomes among people who inject drugs: a global systematic review and meta-analysis. IAS 2023, July 23-26, 2023. Brisbane.
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