Intervention Improves ART Uptake and Decreases Mortality among HIV Infected People who Inject Drugs

UNC researchers, including Irving Hoffman, were part of a team that found an integrated intervention increased HIV medication uptake and decreased mortality among people living with HIV who inject drugs at three international sites. Their results were published in The Lancet.

Intervention Improves ART Uptake and Decreases Mortality among HIV Infected People who Inject Drugs click to enlarge Irving Hoffman

The study, HIV Prevention Trials Network (HPTN) 074, assessed an integrated intervention combining psychosocial counseling and supported referrals for antiretroviral therapy at any CD4 cell count and substance use treatment for people living with HIV who inject drugs compared to the locally available standard of care. The trial was conducted among people who inject drugs in Ukraine, Indonesia and Vietnam. At 52 weeks from enrollment, participants in the intervention arm nearly doubled their antiretroviral therapy usage, viral suppression and substance-use treatment usage compared to the standard of care arm. Mortality was also reduced by more than half with the intervention. Their results were published in The Lancet.

“I believe this very effective, but simple intervention could be applied to populations of people who inject drugs in most settings around the world, and I believe this would result in lives saved and a reduction in HIV transmission,” said Irving Hoffman, PA, MPH, study co-chair and a professor of medicine in the UNC Division of Infectious Diseases.

Overall, 502 people living with HIV and 806 HIV uninfected people with whom they injected drugs entered the study over 15 months and were followed for 12 to 24 months after enrollment. The median age was 35 years. Eighty-five percent of participants enrolled were men; most of the women who participated in the study were enrolled in Ukraine. At week 26, intervention arm participants were twice as likely to report antiretroviral therapy use compared to the standard of care arm participants and twice as likely to achieve an undetectable viral load. The effects persisted at week 52. Among intervention arm participants at week 52, self-reported substance use treatment uptake was higher compared to the standard of care arm participants. Mortality was significantly lower among intervention arm participants and their partners compared to the standard of care arm participants and their partners. Though the study was underpowered to prove the effect of the intervention on HIV transmission no new HIV infections were observed among the partners in the intervention arm, while seven were observed among partners in the standard of care arm.

“The HPTN 074 study assessed the feasibility of an integrated intervention for people living with HIV who inject drugs to reduce HIV transmission to their HIV-uninfected injection partners,” said Myron Cohen, MD, HPTN co-principal investigator and director of the UNC Institute for Global Health and Infectious Diseases. “These study findings related to antiretroviral therapy use and HIV prevention are promising, and this and other interventions are needed to get people living with HIV who inject drugs into care for their own health and to stop transmission of the virus.”

HPTN 074 is funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID), and the U.S. National Institute on Drug Abuse (NIDA), both part of the U. S. National Institutes of Health (NIH).

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